Treatment
Numerous treatment options are available for patients diagnosed with AIDS-related lymphoma. Both standard treatments, which include chemotherapy, radiation therapy, high-dose chemotherapy with stem-cell transplant, and targeted therapy, and treatments being tested in clinical trials are available to patients. Treatment for this type of cancer also involves treatment for AIDS. Because patients with AIDS have weakened immune systems, treating patients with AIDS-related lymphoma is a difficult task that may involve treating with lower doses of drugs than is typical. It is also important to note that for this specific cancer treatment may be different depending on whether the patient has AIDS-related peripheral/systematic lymphoma, lymphoma that starts in the lymph system or elsewhere in the body that is not the brain, or AIDS-related primary central nervous system lymphoma, lymphoma that starts in the central nervous system (spinal cord and brain).
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Chemotherapy
Chemotherapy is used in order to target rapidly growing cancer cells either by killing the cells or stopping them from dividing. Systemic, intrathecal, or regional chemotherapy may be used in order to treat AIDS-related lymphoma. A patient undergoing systemic chemotherapy may take the chemotherapy by mouth or it is injected into a vein or muscle so that the drugs may enter the bloodstream and reach cancer cells throughout the body. Intrathecal chemotherapy involves the direct placement off the chemotherapy into the cerebrospinal fluid and mainly affects the cancer cells in the surrounding area. It is typically used in patients that are suspected to have lymphoma in the central nervous system. Regional chemotherapy may be injected into an organ or body cavity and the drugs mainly affect the cancer cells in the area where the chemotherapy was injected. Rituximab (Rituxan) is a commonly used chemotherapy treatment regimen for AIDS-related lymphoma. Studies have suggested that Rituximab was beneficial in AIDS-related lymphomas, even when there were causes of severe immune deficiencies, and has not been associated with a higher risk of fatal infections.
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Radiation Therapy
Radiation therapy is a type of cancer treatment that utilizes the use of high-energy x-rays and other types of radiation in order to kill cancer cells or stop them from growing. Either external or internal radiation may be used in patients with AIDS-related lymphoma. External radiation therapy involves the use of a machine outside of the body that send radiation towards the cancer. Internal radiation therapy involves the use of radioactive substance that is placed directly into or near cancer. Treatment of AIDS-related primary central nervous system recommended after the completion of chemotherapy to ensure that any lymphoma that was not with chemotherapy regimen as a chemoradiation regimen, and in the case of HIV associated lymphoma, radiation therapy may be combined with CART (combination antiretroviral therapy) as well. However, it is important to still consider the toxicity involved with using combined therapies.
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High Dose Chemotherapy with Stem-Cell Transplant
High dose chemotherapy with stem-cell transplant involves high doses of chemotherapy and aims to replace the blood-forming cells that are destroyed in the process of cancer treatment. Stem cells are removed from the patient or a donor and are frozen ad stored. After chemotherapy, these same stem cells are infused into the patient. The stem cells are then able to grow into and restore the body's blood cells that were damaged by chemotherapy and other forms of treatment. This method of treatment has been shown to be effective in patients with both Hodgkin and non-Hodgkin lymphoma.
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Targeted Therapy
Targeted therapy treatment for patients with AIDS-related lymphoma uses drugs or other substances to identify and attack cancer cells of the tumor itself or otherwise virus infected cells, without harming the healthy body cells. Monoclonal antibody therapy is typically used in the treatment of AIDS-related lymphoma. This type of therapy involves the use of antibodies that can identify substances on cancer cells or normal cells that help cancer cells grow. The antibodies attach to these cells and kill or block their growth and spread. This type of therapy is given by infusion. Since targeted therapies directly attack the cancer cells, they tend to have less side effects than traditional medications such as chemotherapy, which target all rapidly-dividing cells. Overall, these immunotherapies not only target the tumor but also target the principal oncogenes from HIV that eld to development of the tumor.
Clinical Trials
Clinical trials are studies of new cancer treatments that show promise in treatment of the disease. Phase 1 clinical trials introduce a new treatment to a small group of patients to determine if it is safe. Phase 2 clinical trials test if a specific type of cancer is responsive to the new treatment. Phase 3 clinical trials usually compare the new treatment to standard treatments for the disease. Such trials, particularly phase 2 and 3 trials, are designed to offer the best chance of remission using standard or non-standard medications. These trials also answer important questions about how well these medicines work for particular lymphoma. Such trials may also be the best treatment option for patients with lymphomas that have not responded well to traditional treatments.
