Factors associated with survival among patients with AIDS-related primary central nervous system lymphoma.
OBJECTIVE
AIDS-related primary central nervous system lymphoma (AR-PCNSL) has a poor prognosis. Improved understanding of specific patient, infectious, diagnostic, and treatment-related factors that affect overall survival (OS) is required to improve outcomes.


METHODS
Population-based registry linkage study.


METHODS
Adult cases from the San Francisco AIDS registry (1990-2000) were matched with the California Cancer Registry (1985-2002) to ascertain AR-PCNSL data. Survival time was assessed through 31 December 2007. Risk factors and temporal trends for death were measured using two-sided Kaplan-Meier and Cox analyses.


RESULTS
Two hundred and seven AR-PCNSL patients were identified: 68% were white, 20% Hispanic, 10% African-American, and 2% Asian. Nineteen percent of patients had central nervous system (CNS) opportunistic infections diagnosed prior to AR-PCNSL. Fifty-seven percent of patients received radiation and/or chemotherapy and 12% used HAART prior to or within 30 days of AR-PCNSL diagnosis. One hundred and ninety-nine patients died (34 deaths/100 person-years). In adjusted analysis, prior CNS opportunistic infection diagnosis increased risk of death (hazard ratio 1.9, P = 0.0006) whereas radiation and/or chemotherapy decreased risk (hazard ratio 0.6, P < 0.0001). AR-PCNSL diagnosis 1999-2002 had a lower mortality risk (hazard ratio = 0.4, P = 0.02) compared to 1990-1995. African-Americans had an increased risk of death compared to whites or Asians (hazard ratio = 2.0, P = 0.007).


CONCLUSIONS
OS among AR-PCNSL patients improved over time but remains poor, especially among African-Americans. Prospective evaluation of curative therapy in AR-PCNSL is urgently needed. Accurate diagnosis of CNS mass lesions in patients with AIDS is required and for those with AR-PCNSL, antiretroviral therapy with concomitant AR-PCNSL therapy, and antimicrobial supportive care may improve OS.
aHIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute at the National Institutes of Health, Bethesda, Maryland bSan Francisco Department of Public Health cDepartments of Clinical Pharmacy & Medicine, University of California, San Francisco, California, USA.
Thomas S
TS
Uldrick
Sharon
S
Pipkin
Susan
S
Scheer
Nancy A
NA
Hessol
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002140:California; D016543:Central Nervous System Neoplasms / Q000401:mortality*; D005260:Female; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D012495:San Francisco; D016019:Survival Analysis; D055815:Young Adult