Manuel Vaquero

Influence of highly active anti‐retroviral therapy on response to treatment and survival in patients with acquired immunodeficiency syndrome‐related non‐Hodgkin's lymphoma treated with cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone

Combined highly active anti‐retroviral therapy (HAART) with protease and reverse transcriptase inhibitors has modified the natural history of opportunistic infections and neoplasms in human immunodeficiency virus (HIV)‐infected patients. We analysed the influence of HAART on the response to treatment and survival in a series of 58 patients with acquired immune deficiency syndrome (AIDS)‐related non‐Hodgkins lymphoma (NHL) treated with CHOP (cyclophosphamide, hydroxydoxorubicin, vincristine and prednisone). Two groups of patients were included: (i) forty‐one patients diagnosed with NHL between 1988 and 1996 who were not treated with HAART; (ii) seventeen patients diagnosed since 1996, who were receiving or commenced HAART when NHL was diagnosed. The response rate to CHOP was higher in group 2 (13 out of 17 cases; 75%) than in group 1 (14 out of 41 cases; 34%) (P = 0·003). The 2‐year probability of event‐free survival (EFS) [95% confidence interval (CI)] for group 1 was 0·5 (0·24–0·74), whereas for group 2 it was 0·85 (0·61–0·90) (P = 0·024). The lymphoma‐free survival (LFS) was also significantly different for both groups (2‐year LFS probability 0·53 vs. 1·0, P = 0·04). The median (95% CI) overall survival (OS) for group 1 was 7 months (range, 3–10·8 months), whereas it was not reached in group 2 (P = 0·0015). In the multivariate analysis for remission attainment, the only variables with a higher probability to achieve complete remission (CR) were HAART (P = 0·01) and International Prognostic Index score 1 (P = 0·02). The only statistically significant variable in the multivariate analysis for EFS was HAART (P = 0·049) and the variables with prognostic value for OS in the multivariate analysis were B symptoms (P = 0·01) and HAART (P = 0·003). Patients with AIDS‐related NHL treated with CHOP and HAART had a higher CR rate than those treated only with CHOP. In this study, HAART was an independent prognostic factor for CR, OS and EFS in patients with AIDS‐related NHL.

Uterine papillary serous adenocarcinoma. A 10-case study of p53 and c-erbB-2 expression and DNA content.

Background. Uterine papillary serous adenocarcinoma (UPSA) is a highly aggressive neoplasm with a great tendency for dissemination. p53 and c‐erbB‐2 immunoreactivity and DNA ploidy are considered to be indicators of prognosis for endometrial carcinomas.

Detection of Epstein-Barr virus in posttransplantation T cell lymphoma in a kidney transplant recipient: case report and review.

Posttransplantation T cell lymphomas (PTTLs) are rather unusual, and their etiology remains unclear. We describe a case of Epstein-Barr virus (EBV)-associated small bowel T cell lymphoma in a patient 5 years after kidney transplantation. EBV was detected in a biopsy sample by in situ hybridization, immunohistochemical staining, and polymerase chain reaction analysis. Eight previously reported cases of EBV-associated PTTL are reviewed, in which special attention is paid to the methods used for assessing EBV. This case of EBV-associated PTTL is believed to be the most completely studied from the point of view of the methods used for detection of EBV. The prognosis of PTTL is poor, but it has been reported that therapeutic approaches can be successful if they are given early in the course of the illness. Therefore, it is necessary to improve the diagnosis PTTL and to assess the precise involvement of EBV in posttransplantation lymphoproliferative disorders.

AA-type Amyloid Tumor as an Unsuspected Cause of Residual Mass in a Patient With Large B-cell Non-Hodgkin's Lymphoma

Amyloidosis is a rare complication of non-Hodgkins lymphoma (NHL). AL amyloid deposits are usually localized in areas adjacent to the lymphoma, despite the presence of circulating light chains. However, AA-type amyloidosis is extremely unfrequent as a residual mass in patients with NHL. We report a case with diffuse large B-cell non-Hodgkins lymphoma in which a residual tumoral mass corresponding to AA-type amyloidosis was found.

Enfermedad de Hodgkin en pacientes con infección por el virus de la inmunodeficiencia humana. Estudio de 15 casos

Fundamento Aunque la enfermedad de Hodgkin (EH) no se considera como una entidad definitoriade sida, en los pacientes infectados por el VIH presenta unas caracteristicas clinicas ybiologicas diferenciadas. Pacientes y metodos Estudio de las caracteristicas clinicopatologicas y analiticas, de la presenciadel virus de Epstein-Barr (VEB) (reaccion en cadena de la polimerasa) y del pronostico en15 pacientes con EH e infeccion por el VIH diagnosticados en un solo centro durante un periodode 10 anos. Resultados Trece enfermos presentaban signos B; en 10 habia afeccion extraganglionar y12 presentaban una EH avanzada. Los tipos histologicos mas frecuentes fueron la celularidadmixta (6) y la deplecion linfocitica (6). La media (DE) de linfocitos CD4 fue 0,10 (0,08) ×109/l. Se evidencio la presencia del VEB en la biopsia ganglionar en 3 de 4 pacientes analizados.Hubo respuesta completa al tratamiento en 7 de 14 pacientes (50%), la mediana desupervivencia global fue de 26 meses y la probabilidad de supervivencia libre de evento a los2 anos fue del 60%. Conclusiones La EH en los pacientes con infeccion por el VIH se presenta en estadios avanzados,subtipos histologicos desfavorables, frecuente afeccion extraganglionar y presencia de signosB. El pronostico es malo, lo cual se debe, sobre todo, a una baja tasa de respuesta al tratamiento.