Cancer in human immunodeficiency virus-infected children: A case series from the Children's Cancer Group and the National Cancer Institute

Purpose: To describe the spectrum of malignancies in human immunodeficiency virus (HIV)-infected children and the clinical outcome of patients with these tumors. Methods: We retrospectively surveyed the Children's Cancer Group (CCG) and the National Cancer institute (NCI) for cases of cancer that occurred between July 1982 and February 1997 in children who were HIV seropositive before or at the time of cancer diagnosis, We used Kaplan-Meier survivorship curves, hazard function estimates, and Cox proportional hazards models to evaluate survival. Results: Sixty-four children (39 boys, 25 girls) with 65 tumors were reported, Thirty-seven children (58%) acquired HN infection vertically (median age at cancer diagnosis, 4.3 years); 22 children (34%) acquired HIV through transfusion of blood or blood products (median age at cancer diagnosis, 13.4 years). Forty-two children (65%) had non-Hodgkin's lymphoma (NHL), Eleven children (17%) had leiomyosarcomas (or leiomyomas), which are otherwise exceptionally rare in children. Other malignancies included acute leukemia (five children), Kaposi's sarcoma (KS; three children), Hodgkin's disease (two children), vaginal carcinoma in situ (one child), and tracheal neuroendocrine carcinoma (one child), Median survival after NHL diagnosis was 6 months (range, 1 day to 89 months) and after leiomyosarcoma was 12 months (range, 10 days to 19 months), The average monthly death rate after NHL diagnosis was 12% in the first 6 months, which decreased to about 2% thereafter In contrast, the monthly death rate after leiomyosarcoma diagnosis increased from 5% in the first 6 months to about 20% thereafter. Conclusion: After NHL, leiomyosarcoma is the sec and reading cancer in children with HIV infection, Bath cancers have high mortality rates; improved outcome for NHL, in particular, may depend on earlier diagnosis and therapy. (C) 1998 by American Society of Clinical Oncology.