Multiple remissions of extracavitary primary effusion lymphoma treated with a single cycle of liposomal doxorubicin in a patient infected with HIV

  • J. Chen Chronic Viral Illness Service, McGill University Health Centre, Research Institute of the McGill University Health Centre
  • V. Mehraj Chronic Viral Illness Service, McGill University Health Centre, Research Institute of the McGill University Health Centre
  • J. Szabo Chronic Viral Illness Service, McGill University Health Centre, Clinique médicale l’Actuel
  • B. Routy Centre hospitalier de l’Université de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal
  • R. P. Michel McGill University
  • J. P. Routy Chronic Viral Illness Service, McGill University Health Centre, Clinique médicale l’Actuel, McGill University Health Centre, Montreal, QC.
Keywords: hiv, hhv8, primary effusion lymphoma, liposomal doxorubicin, chronic hepatitis E virus infection, Epstein–Barr virus

Abstract

Primary effusion lymphoma (pel) is a rare human herpesvirus 8 (hhv8)–related large B cell lymphoma with plasmablastic, immunoblastic, or anaplastic features that often carries a poor prognosis. This lymphoma occurs mainly in patients with hiv infection, most often with Epstein–Barr virus (ebv) co-infection, and usually presents as body cavity effusions or, less commonly, as extracavitary lesions without effusion (ec-pel). Chemotherapeutic treatment options are limited and require concurrent antiretroviral therapy (art).

Here, we report the case of an adult patient with hiv infection and chronic hepatitis E virus (hev) co-infection who had low CD4 T cell recovery after years of art. The patient then developed a cutaneous ec-pel which rapidly regressed after 1 cycle of liposomal doxorubicin (ld) for his Kaposi sarcoma (ks) before treatment with chop chemotherapy. He had previously received  numerous cycles of ld for cutaneous ks over 2 years.

Because of the patient’s low CD4 T cell count, hev co-infection, and earlier unexpected remission of ec-pel before chop, the patient opted for a single trial of ld before other options. Surprisingly, he experienced a complete remission lasting 18 months. Subsequently, his ec-pel relapsed twice at 31 and at 41 months after the initial diagnosis. Upon recurrence, a similar single cycle of ld was given, which again induced remission. The patient today is in complete remission after a total of 4 ld infusions over 54 months.

This patient represents a unique case of hiv-with-hhv8–related, ebv-negative ec-pel with chronic hev coinfection, in which rapid remission was achieved after a single cycle of ld, suggesting an antiviral response in addition to the chemotherapeutic effect.

Author Biographies

B. Routy, Centre hospitalier de l’Université de Montréal, Centre de recherche du Centre hospitalier de l’Université de Montréal
Division of Hemato-oncology
R. P. Michel, McGill University

Department of Pathology

J. P. Routy, Chronic Viral Illness Service, McGill University Health Centre, Clinique médicale l’Actuel, McGill University Health Centre, Montreal, QC.
Division of Hematology
Published
2018-12-20
How to Cite
Chen, J., Mehraj, V., Szabo, J., Routy, B., Michel, R. P., & Routy, J. P. (2018). Multiple remissions of extracavitary primary effusion lymphoma treated with a single cycle of liposomal doxorubicin in a patient infected with HIV. Current Oncology, 25(6). https://doi.org/10.3747/co.25.4119
Section
Case Report