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JNCI Journal of the National Cancer Institute 2002 94(10):718-732; doi:10.1093/jnci/94.10.718
© 2002 by Oxford University Press
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Journal of the National Cancer Institute, Vol. 94, No. 10, 718-732, May 15, 2002
© 2002 Oxford University Press

REVIEW

Therapeutic Challenges of AIDS-Related Non-Hodgkin's Lymphoma in the United States and East Africa

Mwanda W. Otieno, Cecily Banura, Edward Katongole-Mbidde, John L. Johnson, Mahmoud Ghannoum, Afshin Dowlati, Rolf Renne, Eric Arts, Christopher Whalen, Michael M. Lederman, Scot C. Remick

Affiliations of authors: M. W. Otieno, Department of Haematology and Blood Transfusion, College of Health Sciences, University of Nairobi, and the Kenyatta National Hospital, Nairobi, Kenya; C. Banura, E. Katongole-Mbidde, Department of Medicine, Makerere University School of Medicine and the Uganda Cancer Institute, Mulago Hospital, Kampala, Uganda; J. L. Johnson, E. Arts, M. M. Lederman, Department of Medicine, Case Western Reserve University (CWRU) School of Medicine, Cleveland, OH, and Center for AIDS Research, CWRU; M. Ghannoum, Center for AIDS Research, CWRU, and Department of Dermatology, CWRU; A. Dowlati, Department of Medicine, CWRU, and Comprehensive Cancer Center at University Hospitals of Cleveland and CWRU, Cleveland; R. Renne, S. C. Remick, Department of Medicine, CWRU, Center for AIDS Research, CWRU, and Comprehensive Cancer Center at University Hospitals of Cleveland and CWRU; C. Whalen, Department of Medicine, CWRU, Center for AIDS Research, CWRU, and Department of Biostatistics and Epidemiology, CWRU School of Medicine.

Correspondence to: Scot C. Remick, M.D., University Hospitals of Cleveland Research Institute, 11100 Euclid Ave., BHC-6, Cleveland, OH 44106 (e-mail: scr{at}po.cwru.edu).

Non-Hodgkin's lymphoma (NHL) remains the second most common malignant complication in patients with human immunodeficiency virus (HIV) infection. As we enter the third decade of the acquired immunodeficiency syndrome (AIDS) epidemic, it is apparent that the evolution of antiretroviral therapy and the emergence of combination antiviral strategies have greatly affected the natural history of HIV infection and its neoplastic complications. For example, there may be a trend for declining incidence of AIDS-related lymphoma in the United States for the first time. However, in regions of the world where the burden of HIV infection is greatest, such as in East Africa, AIDS-related lymphoma is an increasing cause of morbidity and mortality. Treatment of lymphoma has evolved coincident with improvements in antiretroviral therapy. Infusional chemotherapy regimens may offer advantages over other regimens and schedules, but comparative trials have not been done. Clinical trial data are available on which to develop therapeutic strategies to treat this disease in East Africa where pragmatic approaches are needed. Both the differences in manifestations of HIV infection and the inherent difficulties in administering cytotoxic chemotherapy in this part of the world must be taken into consideration in planning therapeutic strategies. Improved understanding of the pathogenesis of HIV infection and lymphoma will likely yield improved therapeutic interventions as well.


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