Factors associated with survival among patients with AIDS-related primary central nervous system lymphoma

Abstract

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) are required to improve outcomes. Design 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-PCSNL diagnosis. One hundred and ninety-nine patients died (34 deaths/100 person-years). In adjusted analysis, prior CNS opportunistic infections 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). Conclusion OS among AR-PCSNL 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.

HIV-Associated Malignant Lymphoma

“…The OS among AIDS-related PCNSL patients has improved over time but remains poor [49], and no prospective trials are available.…”

Human immunodeficiency virus‐associated lymphomas in the antiretroviral therapy era: Analysis of the National Cancer Data Base

“…We distinguished outcomes for PCNSL and PEL—2 less common, yet problematic subtypes driven by oncogenic viruses . PCNSL occurs in individuals with advanced AIDS and is often treated using radiation therapy alone or with supportive care only because of patients' poor clinical condition . We observed increased use of chemotherapy in patients with PCNSL after 2009 that was paralleled by increased OS during that period, although expanded use of CART may have caused those gains too, especially because remissions of HIV‐associated PCNSL with CART alone have been reported .…”

“…34 PCNSL occurs in individuals with advanced AIDS and is often treated using radiation therapy alone or with supportive care only because of patients' poor clinical condition. 2,35 We observed increased use of chemotherapy in patients with PCNSL after 2009 that was paralleled by increased OS during that period, although expanded use of CART may have caused those gains too, especially because remissions of HIV-associated PCNSL with CART alone have been reported. 36 Survival curves for patients with PCNSL largely overlapped with the curves for those for PEL in the overall cohort, yet the OS of patients with PCNSL who received chemotherapy was closer to the OS of those with DLBCL/BL, generating a hypothesis that the administration of systemic treatment may translate into better outcomes.…”

Malignant lymphoma in the HIV‐positive patient

“…63 In the cART era, the incidence of AR PCNSL has significantly decreased and the prognosis of patients has improved, mainly due to improved immune function. 64 are eligible for these therapy regimens. High-dose chemotherapy (HDCT) followed by ASCT may be offered to patients responding to intensive induction chemotherapy.…”