32 Immunosuppression-Related Malignancies

Lee Ratner

QUESTIONS

Each of the numbered items below is followed by lettered answers. Select the ONE lettered answer that is BEST in each case unless instructed otherwise.

Question 32.1 In human immunodeficiency virus (HIV)-infected patients, which of the following malignancies is considered to be an acquired immunodeficiency syndrome (AIDS)-defining cancer?

A. Colon cancer

B. Cervical cancer

C. Anal cancer

D. Penile cancer

Question 32.2 Cytotoxic chemotherapy is NOT well tolerated with which of the following antiretroviral medications?

A. Zidovudine, nucleoside reverse transcriptase inhibitor therapy

B. Protease inhibitors

C. Raltegravir, integrase inhibitor

D. Fuzeon, HIV entry inhibitor

Question 32.3 What is the response rate to HAART therapy, in a treatment-naive patient with favorable-risk Kaposi sarcoma (KS)?

A. 20%

B. 40%

C. 60%

D. 80%

Question 32.4 Which of the following is TRUE about the combination of rituximab with chemotherapy for AIDS-associated lymphomas?

A. Adding rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) chemotherapy in patients with CD4 <50/mm³ may result in higher rate of neutropenic infections.

B. Rituximab is of no added benefit to CHOP or infusional etoposide, vincristine, and doxorubicin, bolus cyclophosphamide, and daily prednisone (EPOCH) chemotherapy for AIDS-associated diffuse large B-cell lymphoma (DLBCL).

C. Rituximab with chemotherapy is usually beneficial in plasmablastic lymphoma.

D. Rituximab with chemotherapy is usually beneficial in primary effusion lymphoma.

Question 32.5 Which is TRUE concerning primary central nervous system (CNS) lymphoma in AIDS?

A. Positive cerebrospinal fluid (CSF) Epstein–Barr virus (EBV) polymerase chain reaction (PCR) test and a consistent radiologic picture are sufficient to diagnose primary CNS AIDS lymphoma.

B. In patients with CD4 count <50/mm³ and poor performance status, high dose methotrexate should be instituted.

C. In patients with CD4 count >50/mm³ and good performance status, cranial radiotherapy provides potentially curative therapy.

D. HAART has no role in the treatment of primary CNS lymphoma.

Question 32.6 A 38-year-old man with HIV infection presents with 3-month history of weight loss and night sweats. He is not on antiretroviral therapy and his last CD4 count 3 months ago was 300/mm³. On examination, he has multiple enlarged cervical lymph nodes. His hemoglobin is 10 g/dL, white blood cell count is 3.6 × 10³ /mm³, and platelet count is 190 × 10³/mm³. Serum LDH is 300. Infectious workup is negative. CT of the neck and chest demonstrates diffuse cervical and mediastinal lymphadenopathy. You suspect lymphoma and arrange for an excisional biopsy of a neck lymph node. Which of the following lymphomas is a non-AIDS defining cancer?

A. Hodgkin lymphoma

B. Diffuse large B-cell lymphoma

C. Burkitt lymphoma

D. Primary CNS lymphoma

Question 32.7 Which of the following statements is CORRECT regarding KS?

A. Tumor, node, metastasis (TNM) system is useful for staging KS.

B. Extent of tumor and AIDS-related systemic illnesses is useful in stratifying patients with KS into prognostic risk groups.

C. Response Evaluation Criteria in Solid Tumors (RECIST) is useful in assessing KS response to therapy.

D. All of the above are correct.

Question 32.8 How does the presentation of HIV-associated Hodgkin lymphoma (HL) differ from that of HL in immunocompetent patients?

A. Patients with HIV-associated HL present at an older age.

B. B symptoms are rare in patients with HIV-associated HL.

C. Extranodal sites are less frequently involved in patients with HIV-associated HL.

D. Mediastinal involvement is less frequent in patients with HIV-associated HL.

Question 32.9 Which of the following is CORRECT regarding anogenital cancers in patients infected with HIV?

A. In HIV-infected women with preinvasive cervical neoplasia, standard therapy results in a comparable rate of recurrence, compared to their immunocompetent counterparts.

B. In patients with a CD4 count of less than 200/mm³, who are treated with chemotherapy and radiation for invasive anal cancer, the side effect profile is similar to that of HIV-negative patients

C. In patients with HIV, anal cancer and cervical cancer are associated with high-risk subtypes of human papilloma virus (HPV) infection in the large majority of individuals.

Question 32.10 Which of the following viruses are implicated in the development of cancers in patients with HIV infection?

A. EBV

B. Hepatitis C virus

C. Human herpes virus-8 (HHV-8)

D. All of the above

Question 32.11 A 43-year-old HIV-positive man presents with multiple pigmented skin nodules, hemoptysis and dyspnea without fever or chills, a bloody pleural effusion, and diffuse adenopathy. Biopsy of a 4-cm supraclavicular lymph node is most likely to show:

A. Kaposi Sarcoma.

B. Non-Hodgkin Lymphoma.

C. Tuberculosis.

D. Hodgkin Lymphoma.

Question 32.12 A 45-year-old HIV-positive man on HAART with CD4 240, presents with an anal mass and 3-cm R inguinal node, and biopsy of the anal mass and inguinal node reveal moderately differentiated squamous cell carcinoma. PET examination showed no other evidence of disease. The most appropriate initial treatment is:

A. Cisplatin–Fluorouracil therapy

B. Mitomycin–Fluorouracil therapy concurrent with radiation

C. Abdominoperineal resection

D. Radiation therapy alone

Question 32.13 Sorafenib therapy for hepatocellular carcinoma is well tolerated with which of the following antiretroviral combinations?

A. Truvada and ritonavir boosted prezista

B. Truvada and Raltegravir

C. Atripla

D. Stribild

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