LWBK1006-38 LWW-Govindan-Review December 12, 2011 20:29
Chapter 38•Immunosuppression-Related Malignancies 501methotrexate therapy with leucovorin rescue may be associated with
improved responses, as reported in non-HIV-associated primary CNS
lymphoma.Answer 38.6. The answer is A.
Hodgkin disease is a non-AIDS-defining cancer, whereas Burkitt lym-
phoma, DLBCL, and primary CNS lymphoma are considered to be AIDS-
defining cancers.Answer 38.7. The answer is B.
TNM staging is not useful in KS. The most widely used staging system
is the TIS system, which attempts to stratify risk of poor prognosis in
patients with KS. It is based on the extent of tumor involvement (T),
immune status of the patient (I), and the presence of AIDS-related system
illness. In the era of HAART, assessing the immune system (CD4 count)
does not provide prognostic information in patients with HIV sensitive
to HAART, though is useful in patients with multidrug resistant HIV.
RECIST criteria are not useful in assessing KS response to therapy. The
AIDS Clinical Trials Group Oncology Committee criteria for assessing
response include a 50% decrease in the total number of lesions, a 50%
decrease in the area of measured cutaneous lesions, or a flattening of 50%
of nodular lesions.Answer 38.8. The answer is D.
Patients with HIV-associated HL present at a younger age, B symptoms are
more frequent, and they usually have higher-stage disease at presentation.
Mediastinal involvement is less frequent in patients with HIV-associated
HL, whereas extranodal involvement is more frequent.Answer 38.9. The answer is C.
Cervical cancer and anal cancer in patients infected with HIV appear to
be related to HPV infection. In women who are newly diagnosed with
HIV, cervical cancer screening is recommended. If preinvasive cervical
neoplasia is found, standard therapy (cryotherapy, laser therapy, cone
biopsy, and loop excision) should be used. However, the recurrence rate
in patients with HIV infection is twice that of HIV-seronegative women.
In HIV-infected patients with anal cancer (CD4<200/mm^3 ), who are
treated with chemotherapy and radiation, treatment-related toxicities
(diarrhea, cytopenias) are also significantly higher than those in HIV-
negative patients with anal cancer.Answer 38.10. The answer is D.
EBV is involved in the pathogenesis of HL and the EBV genome has been
detected in tumor nuclei. Hepatitis C and HIV coinfection is common and
leads to increased risk of cirrhosis and hepatocellular carcinoma. HHV-8
is implicated in the development of KS.