BONE MARROW (BM) INVOLVEMENT IN AIDS-LYMPHOMA (AIDS-NHL): CLINICAL, IMMUNOLOGIC AND PATHOLOGIC FEATURES.

Abstract

85 Background: Marrow involvement is reported in approximately 25% of patients (pts) with AIDS-NHL at dx. We report characteristics of marrow involvement in 41 such HIV+ pts. Methods: Retrospective review of all newly diagnosed patients with AIDS-NHL BM biopsies positive for NHL, seen at a single institution between 1984-97. Results: Pts included 40 males and 1 female, with a median age of 37 yrs (25-64). There were 22 Caucasians (54%), 14 (34%) Hispanics, 3 African Americans, and 2 Asians. Fourteen (34%) reported history of AIDS prior to NHL diagnosis. Median CD4 count was 129/mm3 (range 12-1927), and 66% had CD4 counts < 200/mm3. T cell lymphoma was diagnosed in 4 (10%), including 2 T-immunoblastic, 1 anaplastic large cell, and 1 peripheral T cell. 37 (90%) were B cell lymphomas, including 3 with low grade NHL, and the remainder with high or intermediate grade lymphoma, including small non-cleaved in 24 (58%) immunoblastic in 6 (20%), diffuse large cell in 4 (10%). Clinically, systemic "B" symptoms were present in 30 (73%). Other sites of extra-nodal disease included liver in 14 (34%); spinal fluid in 10 (24%), and GI tract in 5 (12%). Lab evaluation at diagnosis revealed a median hemoglobin of 10.6 gm/dl (range 6.3-17), with 41% (16/39) presenting with Hb<10; median WBC was 4.85/mm3 (range 1.9-15.6) with 10 (24%) demonstrating WBC < 4000. Median platelet count was 185,000/mm3 (range 2-504), with 18% demonstrating a platelet < 100,000. Notably, LDH was elevated in 33 (85%); 17 pts had an LDH > 1000. The majority of pts received CHOP (n=16) or mBACOD (n=13) regimens, and 4 were not treated. Median survival was 5.8 months (range 0.2-11.1+ yrs). 9 pts have survived more than 1 year. 2 low grade NHL are alive at 11+ and 11.1+ yrs. Pts with thrombocytopenia had significantly poorer survival (median 1.9 mos versus 6.4 mos, p=0.005); presence of leukopenia or anemia had no impact on survival (p>0.05). Conclusions: (1) The majority of pts with AIDS-NHL and marrow involvement do not present with cytopenias in the peripheral blood; (2) anemia is the most frequent abnormality encountered; (3) pts with thrombocytopenia have poor prognosis; (4) approximately 25% have simultaneous involvement of cerebrospinal fluid; (5) long term survival is possible in HIV+ pts with low grade lymphoma, involving marrow.