Patients with extensive disease—usually Stage IV on the basis of bone marrow and especially central nervous system involvement—and a high serum lactate dehydrogenase (LDH) have generally fared poorly with chemotherapy .
More intensive treatment programs used successfully in pediatric cases, with or without bone marrow transplantation, are under investigation.
Survival data, investigational approaches and therapy for relapsed disease are essentially the same as for lymphoblastic lymphoma.
AIDS-Associated Lymphomas
Intermediate- and high-grade lymphomas are being seen increasingly in HIV-infected patients. These tumors can be highly aggressive. The management of these patients is often challenging because their immune systems are already compromised by the HIV infection. These patients can be extremely sensitive to the bone marrow suppressive effects of chemotherapy and are more likely to develop infectious complications than other lymphoma patients. The "best" chemotherapeutic regimen has yet to be identified, but a number of centers are investigating modified versions of regimens similar to those used for the other intermediate- and high-grade lymphomas. Infectious prophylaxis and hematopoietic growth factors are incorporated in the treatment regimen. HIV-related lymphomas more often primarily involve the central nervous system. In addition to the prognostic
