Whole brain radiation alone produces favourable outcomes for AIDS-related primary central nervous system lymphoma in the HAART era.
Primary central nervous system lymphoma (PCNSL) related to acquired immunodeficiency syndrome (AIDS) is a lethal disorder, but the recent application of highly active antiretroviral therapy (HAART) has significantly improved prognosis. This retrospective cohort study of AIDS-related PCNSL examined the actual clinical outcomes and prognostic variables affecting overall survival (OS) in the HAART era. Twenty-three newly diagnosed AIDS-related PCNSL at 12 regional centre hospitals for HIV/AIDS in Japan between 2002 and 2008 were consecutively enrolled. The estimated 3-yr OS rate of the entire cohort was 64% (95%CI, 41.0-80.3%). Whole brain radiation therapy (WBRT) had an independent positive impact on survival (WBRT >or=30 Gy vs. others, P = 0.02). Nine of 10 patients with a good performance status (PS) (0-2) remained alive with complete response, whereas 10 (77%) of 13 of those with a poor PS (3-4) died mostly after a short period. The estimated 3-yr OS rate of the groups with a good and poor PS was 100% and 38% (95%CI, 14-63%), respectively (P = 0.01). Leukoencephalopathy (grade >or= 2) developed in 21% of those that survived more than 12 months after radiation. The patients receiving a curative intent radiation dose (>or=30 Gy) of WBRT achieved prolonged survival while maintaining a good quality of life in the HAART era, especially among patients with a favourable PS.
Department of Hematology, National Hospital Organization Nagoya Medical Center, Nagoya, Japan. nagaih@nnh.hosp.go.jp
Hirokazu
H
Nagai
Takashi
T
Odawara
Atsushi
A
Ajisawa
Junko
J
Tanuma
Shotaro
S
Hagiwara
Tomoyuki
T
Watanabe
Tomoko
T
Uehira
Hideki
H
Uchiumi
Mihoko
M
Yotsumoto
Toshikazu
T
Miyakawa
Akira
A
Watanabe
Toshiyuki
T
Kambe
Mitsuru
M
Konishi
Seiji
S
Saito
Soichiro
S
Takahama
Masao
M
Tateyama
Seiji
S
Okada
D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D001932:Brain Neoplasms / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D056784:Leukoencephalopathies / Q000209:etiology; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy / Q000503:physiopathology / Q000532:radiotherapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D012074:Remission Induction; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult