Search

The course of disease in 119 HIV-infected patients (117 men, 2 women; median age 38.5 years) with malignant tumours other than Kaposi's sarcoma was analyzed in a multi-centre retrospective study. This was conducted to obtain initial information concerning the incidence, clinical features and results of therapy in HIV-associated neoplasms, especially malignant lymphomas. The most frequent tumour was malignant non-Hodgkin's lymphoma (98 patients, 82.5%), seven patients had Hodgkin's disease, five had solid tumours, four a polyclonal lymphoproliferative syndrome, three an acute lymphocytic leukaemia, and two had other lymphoproliferative diseases. 58% of the non-Hodgkin's lymphomas occurred in patients with marked immunodeficiency, 85% were high grade malignancies and 47% had primary extranodal disease. 56% of primary nodal lymphomas also had visceral spread (Stage IV). Lymphoblastic non-Hodgkin's lymphoma was more common in patients with favourable immunological status, presented less frequently with primary extranodal disease, was diagnosed earlier than other non-Hodgkin's lymphomas, and appeared to carry a better prognosis. 78 out of the 98 patients with non-Hodgkin's lymphoma had been treated, 66 with cytotoxics. The median survival time was 6 months. Longer remission periods, of at least 12 months, were seen in ten of the 78 patients (13%). Despite the overall poor prognosis and the pre-existing immune defect, palliative (chemo-)therapeutic measures are both justified and promising, and may also result in life-prolonging remissions.

Severe haemolytic anaemia developed in a 34-year-old patient with histologically proven alcoholic liver cirrhosis. While in the blood smear there were only a few acanthocytes, under light-microscopy of EDTA-blood 70% of erythrocytes in the counting chamber were acanthocytes or echinocytes, a finding confirmed under the electromicroscope. It is likely that the echinocytosis and acanthocytosis were the cause of the haemolytic anaemia. Biochemical investigation of the lipid composition of the erythrocyte membrane and of plasma and of the apolipoproteins in plasma revealed a series of changes whose role in haemolysis is discussed.

An anaemia (haemoglobin content 8.3 g/dl) of undetermined cause, accompanied by mild jaundice and nocturnal leg oedema, developed in a 68-year-old woman who also had an increased erythrocyte sedimentation rate (128/135 mm). Primary cold-agglutinin anaemia was established as the cause. After administration of prednisone (2 mg/kg body-weight daily), cyclophosphamide (up to 150 mg daily) and plasmapheresis (twice weekly) had failed to bring about improvement, splenectomy achieved a clear reduction of haemolysis. At last examination the haemoglobin content had risen to 12 g/dl. This report demonstrates that in individual cases splenectomy may be useful, but it needs to be determined first by radioisotope study whether the spleen is in fact the main site of erythrocyte sequestration.