Epstein-Barr Virus Infection Is Predictive of CNS Involvement in Systemic AIDS-Related Non-Hodgkin’s Lymphomas

Cingolani, Antonella; Gastaldi, R.; Fassone, Lucia; Pierconti, Francesco; Giancola, Maria Letizia; Martini, Maurizio; Luca, Andrea De; Ammassari, Adriana; Mazzone, Carla; Pescarmona, Edoardo; Gaïdano, Gianluca; Larocca, Luigi Maria; Antinori, Andrea

doi:10.1200/jco.2000.18.19.3325

Cited by 85 publications

(36 citation statements)

References 25 publications

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“…The incidence of CSF involvement at diagnosis ranges from 3% to 15%, and it is related to Burkitt's histology, extranodal involvement, and the use of highly active antiretroviral therapy (HAART). [20][21][22][23] Considering the high risk of progression during the treatment or recurrence during the remission, the use of intrathecal prophylaxis has been considered a mandatory part of the systemic treatment of HIV-NHLs. However, despite the use of standard treatment including methotrexate and/or cytarabine, the CNS recurrence remains a challenge in the outcome of these patients, with a recurrence rate of 4% to 5%.…”

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confidence: 99%

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

Spina

Chimienti

Martellotta

et al. 2010

Cancer

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BACKGROUND:Patients with aggressive non-Hodgkin lymphoma (NHL) develop central nervous system (CNS) progression or recurrence during the course of their disease. Patients with human immunodeficiency virus (HIV)-NHL often develop CNS progression despite the use of prophylaxis. Liposomal cytarabine (DepoCyte) has shown activity in lymphomatous meningitis, but there are limited data for prophylaxis. METHODS: Between May 2006 and December 2008, a phase 2 study of intrathecal liposomal cytarabine was performed at the dose of 50 mg in 30 patients with HIV-NHL, with the aim of evaluating feasibility and activity for prophylaxis. RESULTS: Liposomal cytarabine was well tolerated, with headache grade I to III being the most frequent side effect in 40% of patients. With a median followup of 10.5 months, only 1 (3%) patient developed a combined systemic and meningeal recurrence. The use of liposomal cytarabine allowed significant reduction of the number of lumbar injections in comparison to the standard schedules (around 50%), improving the quality of life of patients and reducing the professional exposure risk. CONCLUSIONS: In this first study on prophylaxis of lymphomatous meningitis in HIV-NHL, liposomal cytarabine seems safe and active; it reduces by approximately 50% the number of lumbar punctures, and exposure risk for health staff as well.

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confidence: 99%

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

Spina

Chimienti

Martellotta

et al. 2010

Cancer

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“…Although the diagnostic value of EBV-DNA for HIV-positive PCNSL is well-documented (3-10, 18), evidence showing its usefulness for identifying CNS lesions of systemic ARL is limited (3)(4)(5)(6)(7)(8)(9)(10). Since the prevalence (21.7%) of CNS involvement in patients with systemic ARL is considerably higher (3) than that of non-HIV lymphoma patients (2-7%) (14-16), our results might support the clinical utility of evaluating EBV-PCR with CSF in the management of patients with HIV-positive systemic ARL.…”

Section: Discussionmentioning

confidence: 99%

“…Although the incidence of AIDS-related lymphoma (ARL) has decreased following the advent of highly active antiretroviral therapy (HAART), the morbidity and mortality associated with this complication remain significant due to the aggressive clinical course and high frequency of extra nodal localization especially in the central nervous system (CNS) (1)(2)(3). Since the majority of patients with ARLs are diagnosed at the advanced stage of HIV infection, making the differential diagnosis of CNS lesions from other opportunistic diseases is crucial for the management of ARL.…”

Section: Introductionmentioning

confidence: 99%

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Epstein-Barr Viral Load in Cerebrospinal Fluid as a Diagnostic Marker of Central Nervous System Involvement of AIDS-related Lymphoma

et al. 2013

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Objective AIDS-related lymphoma (ARL) often involves the central nervous system (CNS). Although the diagnostic value of Epstein-Barr virus (EBV)-DNA in cerebrospinal fluid (CSF) in detecting HIV-positive primary CNS lymphoma (PCNSL) has been established, its usefulness for identifying CNS involvement of systemic ARL remains elusive. In this study, we evaluated the utility of the EBV-DNA load in CSF in identifying CNS involvement in patients with systemic ARL. Methods We retrospectively reviewed the clinical and pathological data of consecutive ARL patients managed at our clinic between January 1998 and June 2012. Sixty-two patients with ARL, including eight PCNSL patients and 52 systemic ARL patients, and 63 controls underwent CSF EBV-DNA load evaluations before receiving chemotherapy. ARL-related CNS involvement was defined as any lesion diagnosed histologically or radiologically as a lymphoma in the brain, meninges, spine, cranial nerves or oculus. Results A cut off value of 200 copies/mL predicted the presence of CNS lesions with a sensitivity of 70% and a specificity of 85% in both the PCNSL and systemic ARL patients, while a sensitivity of 75% and a specificity of 93% were obtained for systemic ARL. A cut off value of 2,000 (3.30 log) copies/mL provided the best specificity (100%), with a sensitivity of 50%. Conclusion Our results support the clinical utility of evaluating the quantitative EBV-DNA load in the CSF for the diagnosis of CNS involvement of systemic ARL as well as PCNSL.

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“…32 In a study of 50 patients with systemic ARL, Cingolani and colleagues 45 showed that presence of EBV infection in the primary tumor was an independent predictor for CNS lymphomatous involvement at diagnosis or eventual relapse. In addition, the authors also demonstrated that detection of EBV DNA in CSF by polymerase chain reaction could predict eventual CNS lymphomatous involvement in almost 100% of patients, 45 suggesting that the detection of EBV DNA in CSF may be used to select patients who would most benefit from CNS prophylaxis. Clinically, CNS chemoprophylaxis should be considered for patients with Burkitt lymphoma or with bone marrow, paraspinal, paranasal, epidural, testicular, or widespread systemic involvement.…”

Section: Role Of Central Nervous System Prophylaxismentioning

confidence: 99%

Recent Advances in Acquired Immunodeficiency Syndrome (AIDS)-related Lymphoma

Lim

Levine

2005

CA: A Cancer Journal for Clinicians

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Human immunodeficiency virus-infected patients are at an increased risk for developing both Hodgkin and non-Hodgkin lymphoma when compared with the general population. With the remarkable decrease in the incidence of opportunistic infections since the availability of highly active antiretroviral therapy (HAART), acquired immune deficiency syndrome-related lymphoma (ARL) is now the second most common cancer associated with human immunodeficiency virus after Kaposi sarcoma. Over the last few years, advances in our understanding of the molecular biology of this heterogeneous group of lymphomas have led to the adoption of new classification systems. The prognosis of patients with ARL has improved dramatically with the availability of HAART, and the survival of many of these patients is now comparable to patients in the general population. Apart from the contribution of HAART, this improvement in prognosis can also be attributed to new initiatives in treatment of these patients, such as the use of effective infusional regimens, the feasibility of high-dose therapy with peripheral stem cell rescue for relapsed or refractory disease, and better supportive care. Nonetheless, several controversial issues persist, including the optimal timing of HAART with combination chemotherapy, the role of rituximab when incorporated into treatment regimens, and the optimal therapy for patients with acquired immunodeficiency syndrome-related Burkitt lymphoma. This article reviews the changes in the epidemiology of ARL in the era of HAART, advances in the biology of ARL, new developments in the management of patients with ARL, and several of the controversial issues that oncologists may encounter in the care of these patients. (CA Cancer J Clin 2005;55:229 -241.)

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Epstein-Barr Virus Infection Is Predictive of CNS Involvement in Systemic AIDS-Related Non-Hodgkin’s Lymphomas

Cited by 85 publications

References 25 publications

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

Epstein-Barr Viral Load in Cerebrospinal Fluid as a Diagnostic Marker of Central Nervous System Involvement of AIDS-related Lymphoma

Recent Advances in Acquired Immunodeficiency Syndrome (AIDS)-related Lymphoma

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