title: Treatment of HIV-related primary central nervous system lymphoma with AZT high dose, HAART, interleukin-2 and foscarnet in three patients.
abstract: OBJECTIVE
  Combined immunomodulatory and antiviral treatment was administered to three patients with newly diagnosed HIV-associated primary central nervous system lymphoma (PCNSL) in an attempt to improve outcomes.
  
  
  METHODS
  Three patients from our institution who were recently diagnosed with HIV-associated PCNSL received intravenous azidothymidine (AZT) 1.6 gr. bid for two weeks, followed by oral AZT 250mg bid from day 15. In addition, complementary highly active antiretroviral therapy (HAART) with a second nucleoside reverse transcriptase inhibitor (NRTI) plus one protease inhibitor (PI) and interleukin 2 (IL-2) subcutaneously 2 million units twice daily (bid) plus foscarnet 90mg/kg bid were administered on days 1-14. One patient received anti-Epstein-Barr virus (EBV)-maintenance therapy with ganciclovir, followed by cidofovir.
  
  
  RESULTS
  All patients experienced progressive disease while on induction therapy, and switched early to whole-brain radiation therapy (WBRT) as second line-treatment. No grade 3 or 4 toxicities were observed. Two patients died on days 50 and 166 respectively due to progressive disease. The third patient with histo?logically proven lymphoproliferation and only suspected PCNSL remained alive at 53 months. He was on HAART and remained clinically and neurologically stable.
  
  
  CONCLUSIONS
  Although IL-2, HAART, high-dose AZT and foscarnet are used for other HIV-related conditions, they did not demonstrate benefit in lymphoma remission for 2 HIV- associated PCNSL patients. The third patient went into delayed remission after additional radiotherapy and was in good clinical and neurological health status over 53 months after diagnosis.
authors: DRK-Kliniken Köpenick, Berlin, II. Innere Abteilung, Hämato-Onkologie, Salvador-Allende-Allee 2-8, 12559 Berlin, Germany. l.marretta@drk-kliniken-berlin.de
authors: Lore
authors: L
authors: Marretta
authors: H
authors: H
authors: Stocker
authors: D
authors: D
authors: Drauz
authors: M
authors: M
authors: Mueller
authors: A
authors: A
authors: Masuhr
authors: S
authors: S
authors: Dieckmann
authors: V
authors: V
authors: Wong
authors: A
authors: A
authors: Koch
authors: A
authors: A
authors: Grueneisen
authors: K
authors: K
authors: Arastéh
authors: R
authors: R
authors: Weiss
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D016543:Central Nervous System Neoplasms / Q000188:drug therapy*; D017245:Foscarnet / Q000008:administration & dosage / Q000627:therapeutic use*; D006801:Humans; D007376:Interleukin-2 / Q000008:administration & dosage / Q000627:therapeutic use*; D016483:Lymphoma, AIDS-Related / Q000188:drug therapy*; D008297:Male; D015215:Zidovudine / Q000008:administration & dosage / Q000627:therapeutic use*
chemical_list: D007376:Interleukin-2; D017245:Foscarnet; D015215:Zidovudine