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• W2043293604 abstract "Extranodal marginal zone B-cell lymphomas of mucosa-associated lymphoid tissue (MALT lymphomas) have been rarely reported in the setting of human immunodeficiency virus type-1 (HIV-1) infection. To our knowledge, no previous study has characterized MALT lymphomas in HIV-1 or HIV-2-infected adults. Consequently, no specific guidelines have been established regarding their treatment, and nothing is known about their outcome in the context of highly active antiretroviral therapy (HAART). The present study includes eight HIV-1 or HIV-2-infected patients diagnosed with MALT lymphoma between January 1997 and December 2006 in six French hospitals (Table I). The lymphoma involved the stomach in six cases, lung and stomach in one case and parotid and submaxillary glands in one case. Histological analysis of tumour biopsy samples showed the typical features of MALT lymphoma in all cases. Tumour cells consisted of CD20+ CD3− CD5− BCL2+ CD10− CD23− centrocyte-like cells forming characteristic lymphoepithelial lesions. Marked plasma cell differentiation and CD138 expression were observed in the lung of patient 1. Each of the five cases studied showed a moderate expression of BCL10 in both nucleus and cytoplasm of all tumour cells. Concomitant Helicobacter pylori (H. pylori) gastritis was documented in six patients. In patient 5, histology of a partial gastrectomy specimen that was collected 2 months after MALT lymphoma diagnosis, showed rare clusters of large lymphoid cells, suggesting focal transformation into diffuse large B-cell lymphoma (DLBCL). Similar features were observed in gastric biopsies from patient 4. In patient 8, histological analysis of the lung biopsy collected at the time of relapse, showed a diffuse infiltrate of large CD20+ CD5− CD10− BCL2− centroblasts. Evidence for expansion of a B-cell monoclonal population was found in six cases using polymerase chain reaction (PCR) amplification of immunoglobulin heavy chain gene (IGH@) rearrangements and/or fluorescence in situ hybridization (FISH) detection of a translocation involving IGH@ (http://www.euro-fish.org). Reverse transcription-PCR detection of BIRC3-MALT1 fusion transcript and/or FISH analyses showed the presence of t(11;18)(q21;q21) in one case. FISH analyses failed to detect any rearrangement of BCL10. The five patients with H. pylori-associated gastric MALT lymphoma received antibiotherapy, leading to eradication of H. pylori and complete remission (CR) of lymphoma in all cases but one (Table II). One patient was treated with partial gastrectomy and CHOP for H. pylori-negative gastric MALT lymphoma with focal DLBCL. Another patient underwent pulmonary surgery. The patient with salivary gland lymphoma received rituximab, which led to partial remission, but the disease subsequently transformed into lung DLBCL. Upon lymphoma diagnosis, five patients received antiretroviral treatment, consisting of HAART in two of them. In the other six patients, HAART was started 0–30 months after lymphoma diagnosis. At the time of last follow-up, the plasma HIV RNA load was <200 copies/ml in six patients, including four in CR. After a median follow-up of 76 months, seven patients were alive, including four in CR and three with stable disease. One patient died following a cerebrovascular accident at 66 months, while in CR. Our study represents the largest series of well-documented HIV-1 or HIV-2-associated MALT lymphomas reported to date. The present patients shared several features with the nineteen cases of MALT lymphoma previously reported in HIV-1-infected adults (Coker et al, 1992; Rivas et al, 1993; Rodriguez-Sanjuan et al, 1996; Wotherspoon et al, 1996; Chetty & Pillay, 1999; Ribeiro et al, 2001; Girard et al, 2005; Cortot et al, 2006) or children (Joshi et al, 1997). In HIV-1-infected children, MALT lymphoma was frequently associated with lymphocytic interstitial pneumonitis or lymphoepithelial sialadenitis (Joshi et al, 1997). The main sites involved were the stomach (Wotherspoon et al, 1996), lungs (Cortot et al, 2006), salivary glands (Joshi et al, 1997), Waldeyer ring and ocular adnexa (Girard et al, 2005). In previous reports, HIV-1-associated MALT lymphomas have been rarely characterized at the molecular level. To date, the unique case of t(11;18)(q21;q21)-positive MALT lymphoma reported in a HIV-1-infected patient involved the lung (Cortot et al, 2006). In the present series, t(11;18)(q21;q21) was detected with the expected frequency (one of eight cases) and as reported in a H. pylori-negative gastric MALT lymphoma at advanced stage (Isaacson & Du, 2004). From previous case reports, MALT lymphoma seems to have an indolent course during the setting of HIV-1 infection. Most patients reported in the literature were still alive several months after diagnosis, even when they failed to achieve CR. Only two patients died from causes unrelated to lymphoma progression (Rivas et al, 1993; Rodriguez-Sanjuan et al, 1996). In three patients with HIV-1-associated MALT lymphoma, it has been reported that the use of HAART, either alone (Girard et al, 2005) or associated with rituximab (Cortot et al, 2006) or H. pylori eradication therapy (Ribeiro et al, 2001), led to CR of lymphoma, suggesting a possible benefit from the control of HIV-1 replication. Among the six previously published cases of HIV-1-associated MALT lymphoma involving the stomach, H. pylori infection was tested for in four cases and documented in three of them. Only one patient received H. pylori eradication therapy (Ribeiro et al, 2001) whereas the others, diagnosed in the 1990’s, underwent gastrectomy (Coker et al, 1992; Rivas et al, 1993; Rodriguez-Sanjuan et al, 1996; Wotherspoon et al, 1996; Chetty & Pillay, 1999). In H. pylori-associated gastric MALT lymphoma developed in HIV-1-negative patients, eradication of H. pylori leads to CR of lymphoma in about 75% of cases (Isaacson & Du, 2004). In the present series, CR was obtained in four of five patients after the cure of H. pylori infection. Our data showed that, in the context of HAART, most of the MALT lymphomas developed in HIV-1 or HIV-2-infected patients were associated with a favourable outcome, as reported in HIV-1-negative individuals. Among other factors, the control of HIV-1 or HIV-2 replication might have a positive impact on the disease. In HIV-1-infected patients with H. pylori-associated gastric MALT lymphoma, H. pylori eradication therapy associated with HAART is beneficial and should be prescribed as the first-line treatment. In patients with non-responsive or H. pylori-independent MALT lymphoma, other treatment modalities, such as chlorambucil and/or rituximab, or radiation therapy, should be considered. E.B. was financially supported by the French Foundation Sidaction Ensemble contre le SIDA. The authors are grateful to Drs Michelle Bentata and Antoine Martin (Hôpital Avicenne, Bobigny), Cécile Goujard and Thierry Lazure (Hôpital Bicêtre, Le Kremlin Bicêtre), Dominique Salmon and Michelline Tulliez (Hôpital Cochin, Paris), Marc-Antoine Valantin, Jean Gabarre and Frédéric Charlotte (Hôpital Pitié Salpêtrière, Paris), Raphael Borie and Josette Brière (Hôpital Saint-Louis, Paris), Michaël Levy, Jean-Charles Delchier and Yves Lévy (Hôpital Henri Mondor, Créteil) for providing them with clinical data and pathological samples from the patients, and Pierre Boulanger (Faculté de Médecine Laennec, Lyon) for his critical reading of the manuscript." @default.
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• W2043293604 date "2008-01-21" @default.
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• W2043293604 title "Mucosa-associated lymphoid tissue lymphoma in patients with human immunodeficiency virus infection" @default.
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