title: Patterns of central nervous system recurrence in patients with systemic human immunodeficiency virus-associated non-hodgkin lymphoma.
abstract: BACKGROUND
  Central nervous system involvement is a common manifestation of non-Hodgkin lymphoma (NHL) in human immunodeficiency virus (HIV)-infected individuals. The purpose of this study was to review the frequency and pattern of neurologic manifestation of lymphoma in a cohort of HIV-infected individuals with systemic NHL.
  
  
  METHODS
  Sixty-two patients with HIV-associated systemic NHL received infusional cyclophosphamide, doxorubicin, and etoposide. Five patients with lymphomatous meningitis at presentation received whole brain radiation therapy plus intrathecal chemotherapy (ITC). Of the remaining 57 patients, prophylactic ITC was recommended only for those patients with lymphomatous bone marrow involvement and/or high grade histology (N = 31).
  
  
  RESULTS
  Thirteen patients (21%) had histologically documented (N = 6) or presumed (N = 7) central nervous system involvement, including 7 patients (11%) with meningeal lymphoma discovered either at presentation (N = 5) or soon after diagnosis (N = 2), and 6 patients (10%) with cerebral mass lesions at the time of disease recurrence consistent with parenchymal brain involvement. Five of six parenchymal brain recurrences occurred in the setting of progressive systemic disease. Four of 7 patients (57%) with meningeal lymphoma detected at presentation (N = 5) or within 3 months of presentation (N = 2) responded to therapy and survived >1 year. Of the 26 patients assigned to receive no prophylactic ITC, no patient developed an isolated meningeal recurrence and 1 patient developed an isolated parenchymal brain recurrence.
  
  
  CONCLUSIONS
  The findings of the current study suggest that in patients with HIV-associated systemic lymphoma, meningeal lymphoma is potentially curable, parenchymal brain recurrence usually occurs in the setting of uncontrolled systemic disease, and prophylactic ITC may not be necessary for patients with intermediate grade histology and uninvolved bone marrow.
authors.affiliation: Department of Radiation Oncology, Albert Einstein Comprehensive Cancer Center, Montefiore Medical Center, Bronx, New York 10467, USA.
authors.forename: J
authors.initials: J
authors.lastname: Desai
authors.forename: R J
authors.initials: RJ
authors.lastname: Mitnick
authors.forename: D H
authors.initials: DH
authors.lastname: Henry
authors.forename: J
authors.initials: J
authors.lastname: Llena
authors.forename: J A
authors.initials: JA
authors.lastname: Sparano
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000517:prevention & control / Q000556:secondary*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005047:Etoposide / Q000008:administration & dosage; D005260:Female; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000150:complications / Q000188:drug therapy / Q000473:pathology*; D008297:Male; D008581:Meningitis / Q000150:complications; D008875:Middle Aged; D011446:Prospective Studies; D055502:Secondary Prevention
chemical_list: D005047:Etoposide; D004317:Doxorubicin; D003520:Cyclophosphamide