|AIDS and Non-Hodgkins on the rise
Mar 2, 2001
I was diagnosed with AIDS related Non-Hodgkins one year ago, April 7, 1998, Stage IV (bone marrow involvement). My tumor was removed, 5 cm node in my pelvic area. I received six CHOP chemo treatments and was pronounced in remission after the second treatment. I also had 4 spinal tap infusions as prophylaxis. I have three questions 1) Statistically, what are my chances of survival and/or reoccurrence? 2) What is your opinion on IL2 therapy to prevent reoccurrence 3) In your opinion as HIVers live longer will there be a greater number on cases of NHL down the road?
Response from Dr. Dezube
Three excellent questions. 1) The first thing to say is that six CHOP treatments plus 4 spinal tap infusions (in certain instances) is indeed the standard of care. You can feel comforted by the fact that you got state of the art treatment. The likelihood of the cancer coming back depends on your CD4 count and viral load. The higher the CD4 count and the lower the viral load, the less likely that your tumor will return. That said, there are obviously no guarantees. Please note that the further you are out from chemotherapy, the more the CD4 count will rise. If your CD4 count is higher than 200 and your viral load is low, then the chances of you doing well long term are very good to excellent.
2) IL-2 in this setting is experimental. I personally don't use it in this setting (to prevent recurrence) though I will admit that I participated in an NIH protocol which tested IL-2 in HIV-lymphoma patients. At this point in time, I would not recommend it outside of a clinical trial.
3) HIV-lymphoma is caused by constant irritation (stimulation) of the immune system. Data do indeed show that as HIVers are living longer, we can expect (and indeed we are seeing) a steady stream of lymphoma patients. The good news is that one serious form of lymphoma -- lymphoma of the brain (also known as primary CNS lymphoma) is way down. Also the treatments in the year 2000 and the supportive care are much better than they were in the pre-HAART era.
In short, the best advice I can give you is to stay on HAART and enjoy the rich perspective of life, which one often gets having survived such an ordeal.
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