title: Central nervous system involvement in AIDS-related lymphomas.
abstract: Central nervous system (CNS) involvement is reportedly more common in acquired immunodeficiency syndrome (AIDS)-related lymphomas (ARL). We describe factors and outcomes associated with CNS involvement at baseline (CNS(B) ) and relapse (CNS(R) ) in 886 patients with newly diagnosed ARL. Of 886 patients, 800 received either intrathecal (IT) therapy for CNS(B) or IT prophylaxis. CNS(B) was found in 13%. CNS(B) was not associated with reduced overall survival (OS). There was no difference in the prevalence of CNS(B) between the pre-combination antiretroviral therapy (cART) and cART eras. 5·3% of patients experienced CNS(R) at a median of 4·2 months after diagnosis (12% if CNS(B) ; 4% if not). Median OS after CNS(R) was 1·6 months. On multivariate analysis, only CNS(B) [hazard ratio (HR) 3·68, P = 0·005] and complete response to initial therapy (HR 0·14, P < 0·0001) were significantly associated with CNS(R) . When restricted to patients without CNS(B) , IT CNS prophylaxis with 3 vs. 1 agent did not significantly impact the risk of CNS(R) . Despite IT CNS prophylaxis, 5% of patients experienced CNS(R) . Our data confirms that CNS(R) in ARL occurs early and has a poor outcome. Complete response to initial therapy was associated with a reduced frequency of CNS(R) . Although CNS(B) conferred an increased risk for CNS(R) , it did not impact OS.
authors.affiliation: Fox Chase Cancer Center, Philadelphia, PA, USA.
authors.forename: Stefan K
authors.initials: SK
authors.lastname: Barta
authors.affiliation: Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Jitesh
authors.initials: J
authors.lastname: Joshi
authors.affiliation: Centre Hospitalier Universitaire l'Archet, Nice, France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Mounier
authors.affiliation: Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Xiaonan
authors.initials: X
authors.lastname: Xue
authors.affiliation: Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Dan
authors.initials: D
authors.lastname: Wang
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Josep Carreras Research Institute Badalona, Badalona, Spain.
authors.forename: Josep-Maria
authors.initials: JM
authors.lastname: Ribera
authors.affiliation: Hospital Universitari Germans Trias i Pujol, Josep Carreras Research Institute Badalona, Badalona, Spain.
authors.forename: Jose-Tomas
authors.initials: JT
authors.lastname: Navarro
authors.affiliation: IPM Study Centre, Hamburg, Germany.|University of Schleswig-Holstein, Kiel, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Hoffmann
authors.affiliation: National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA.
authors.forename: Kieron
authors.initials: K
authors.lastname: Dunleavy
authors.affiliation: National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA.
authors.forename: Richard F
authors.initials: RF
authors.lastname: Little
authors.affiliation: National Cancer Institute at the National Institutes of Health, Bethesda, MD, USA.
authors.forename: Wyndham H
authors.initials: WH
authors.lastname: Wilson
authors.affiliation: Division of Medical Oncology A, National Cancer Institute, Aviano, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Spina
authors.affiliation: Department of Clinical Immunology, Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris and Univ Paris Diderot, Sorbonne Paris Cité, Paris, France.
authors.forename: Lionel
authors.initials: L
authors.lastname: Galicier
authors.affiliation: Memorial Sloan-Kettering Cancer Center & Weill Cornell New York, New York, NY, USA.
authors.forename: Ariela
authors.initials: A
authors.lastname: Noy
authors.affiliation: Albert Einstein College of Medicine/Montefiore Medical Center, Bronx, NY, USA.
authors.forename: Joseph A
authors.initials: JA
authors.lastname: Sparano
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000209:etiology* / Q000401:mortality / Q000628:therapy; D016208:Databases, Factual; D005260:Female; D006801:Humans; D016483:Lymphoma, AIDS-Related / Q000150:complications* / Q000188:drug therapy / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011292:Premedication; D012008:Recurrence; D012074:Remission Induction / Q000379:methods; D015996:Survival Rate; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents
keywords: AIDS-related lymphoma; acquired immunodeficiency syndrome; central nervous system relapse; lymphoma; non-Hodgkin lymphoma