Primary CNS lymphoma in HIV positive and negative patients: comparison of clinical characteristics, outcome and prognostic factors

Abstract

Primary central nervous system lymphoma (PCNSL) accounts for approximately 4% of all primary brain tumors and has a poor prognosis in both immunocompetent as well as in immunocompromised patients. We conducted a retrospective analysis to examine the clinical characteristics and prognostic factors in HIV-negative and HIV-positive patients with PCNSL and to assess the effect of highly active antiretroviral therapy (HAART) therapy on the outcome of HIV-positive patients. Patients diagnosed with PCNSL between 1999 and 2008 at our institution were divided into two groups based on their HIV status. Their demographic and clinical characteristics were compared using the chi-square test. Kaplan-Meier survival curves were constructed employing the univariate log-rank test. Multivariate analyses of survival were performed by Cox proportional hazards models incorporating the prognostic factors identified in the univariate log rank test. Forty-one HIV-positive patients and 45 HIV-negative patients were identified. HIV-positive patients were younger, more likely to present with seizures and elevated serum LDH levels. There were significant differences in complete remission (CR) rates (P = 0.010) and overall survival (OS) (P = 0.034) in favor of the HIV-negative group. In the HIV-positive group, OS was better in patients with KPS > 70 and patients who received HAART, but remained inferior to that in the HIV-negative patients. HIV-positive patients had a worse prognosis compared to HIV-negative patients despite similar clinical characteristics. Better performance status (KPS > 70) and treatment with HAART conferred better OS in HIV-positive patients.

Primary CNS Lymphoma

“…Incidence inversely correlates with CD4 counts and, historically, survival was strongly influenced by HIV-related comorbidities. In the cART era, the frequency of HIV-associated PCNSL has fallen whilst survival has improved [91], although outcomes remain inferior to those of immunocompetent patients [92]. Surrogate measures are often used for diagnosis, using a combination of thallium-201 SPECT scanning and presence of EBV in the CSF [93, 94], therefore availability of diagnostic material for biologic studies is limited.…”

“…Use of either WBRT or chemotherapy independently reduced the risk of death in a large retrospective HIV-PCNSL cohort [91]. HD-MTX-based regimens have been tolerated in immunodeficient patients, but trials in the cART era are lacking [97] and data is particularly scarce on patients receiving combination chemotherapy [92, 98]. There is an isolated case report of successful ASCT [99].…”

Lymphoid Proliferations Associated With Human Immunodeficiency Virus Infection

“…Most of these cases occur in patients who are severely immunosuppressed, with more than 90% of patients presenting with a CD4 count of less than 200/lL and approximately 60% to 70% of those patients having a CD4 of less than 50/lL. 136 Most primary CNS lymphomas exhibit immunoblastic features. Usually the neoplastic cells are EBV þ , and many express the EBV latency II gene product, latent membrane protein 1 (LMP1), suggesting that they are EBV driven.…”

“…Usually the neoplastic cells are EBV þ , and many express the EBV latency II gene product, latent membrane protein 1 (LMP1), suggesting that they are EBV driven. 98,[136][137][138] Furthermore, HIV-related, primary CNS lymphoma is aggressive with a median overall survival for those treated aggressively with both chemotherapy and whole brain radiation of only 3.4 months. 136 Lymphomas Occurring More Specifically in HIV þ Patients…”

Combined Diffusion and Perfusion MR Imaging as Biomarkers of Prognosis in Immunocompetent Patients with Primary Central Nervous System Lymphoma

“…6 In immunocompetent individuals, however, the disease etiology remains unknown and prognosis can be highly variable. 7 Several markers of adverse prognosis have been suggested such as age older than 60 years, low performance scores, high lactate dehydrogenase level, high CSF protein level, enhancing lesions involving the brain stem, 8,9 and no initial response to steroids. 10 However, noninvasive biomarkers of prognosis and tumor biology that can be measured serially and quantitatively are needed to identify high-risk subgroups at initial diagnosis for formulation of a personalized therapeutic strategy, to assess response to therapy, and to detect tumor recurrence without delay.…”