Human immunodeficiency virus–related primary central nervous system lymphoma

Factors influencing survival in 111 patients

Authors

  • Mark E. Newell M.B.B.S., M.P.H.,

    1. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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  • Jennifer F. Hoy M.B.B.S.,

    1. Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia
    2. Department of Medicine, Monash University, Melbourne, Australia
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  • Stephen G. Cooper M.B.B.S.,

    1. Department of Radiation Oncology, St. Vincent's Hospital, Sydney, Australia
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  • Bernadette DeGraaff B.Sc.,

    1. Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia
    2. Department of Medicine, Monash University, Melbourne, Australia
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  • Andrew E. Grulich Ph.D.,

    1. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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  • Melissa Bryant B.Sc.,

    1. Infectious Diseases Unit, Alfred Hospital, Melbourne, Australia
    2. Department of Medicine, Monash University, Melbourne, Australia
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  • Jeremy L. Millar M.B.B.S.,

    1. William Buckland Radiation Therapy Centre, Alfred Hospital, Melbourne, Australia
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  • Bruce J. Brew M.B.B.S., M.D.,

    1. National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, Australia
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  • David I. Quinn M.B.B.S., Ph.D.

    Corresponding author
    1. Department of Clinical Pharmacology and Toxicology, University of New South Wales, Sydney, Australia
    Current affiliation:
    1. Division of Medical Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
    • Division of Medical Oncology, Keck School of Medicine, University of Southern California, 1441 Eastlake Avenue, Suite 3453, Los Angeles, CA 90033
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    • Fax: (323) 865-0061


Abstract

BACKGROUND

The current study evaluated factors influencing survival in patients diagnosed with human immunodeficiency virus (HIV)-related primary central nervous system lymphoma (PCNSL), with a focus on the effects of therapeutic radiotherapy (RT) and highly active antiretroviral therapy (HAART).

METHODS

A retrospective chart review of patients with a diagnosis of HIV-related PCNSL at one of five university hospitals between 1987 and 1998 was performed. Clinical details including antiretroviral agent use, brain imaging scan results, RT use, and survival outcomes were recorded.

RESULTS

One hundred eleven patients with HIV-related PCNSL were identified. The annual incidence decreased significantly between 1992 and 1995 and between 1996 and 1998 (P = 0.04). The median survival period was 50 days (mean, 109 days; range, 4–991 days), with improved survival for patients diagnosed after 1993. Patients treated with two or more antiretroviral agents had improved survival (P = 0.01), as did patients who received RT (P < 0.0001). For patients who received RT, completion of the prescribed course and treatment to ≥ 30 Gray (Gy) independently predicted a more favorable outcome. RT used in conjunction with antiretroviral therapy involving two or more agents had an additive positive effect on survival. For patients who did not receive RT, poor performance status and encephalopathy predicted a shorter survival duration.

CONCLUSIONS

The results of the current study suggest that HAART and treatment with RT to ≥ 30 Gy improve survival for patients with HIV-related PCNSL. This combination of therapies may provide a standard of care as the basis for further trials of chemotherapy, novel adjunctive treatment, and quality of life assessment. Cancer 2004. © 2004 American Cancer Society.

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