Whole brain radiation alone produces favourable outcomes for AIDS‐related primary central nervous system lymphoma in the HAART era

Nagai, Hirokazu; Odawara, Takashi; Ajisawa, Atsushi; Hagiwara, Shotaro; Watanabe, Tetsu; Uehira, Tomoko; Uchiumi, Hideki; Yotsumoto, Mihoko; Miyakawa, Taihei; Watanabe, Akira; Kambe, Toshiyuki; Konishi, Mitsuru; Saito, Seiji; Takahama, Soichiro; Tateyama, Masao; Okada, Seiji

doi:10.1111/j.1600-0609.2010.01424.x

Cited by 22 publications

(20 citation statements)

References 27 publications

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“…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].…”

Section: Treatmentmentioning

confidence: 99%

Primary CNS Lymphoma

Phillips

Fox

Cwynarski

2014

Curr Hematol Malig Rep

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Primary diffuse large B-cell lymphoma (DLBCL) of the central nervous system is an aggressive malignancy that exhibits unique biological features and characteristic clinical behaviour, with overall long-term survival rates of around 20–40 %. Clinical outcome has improved following the advent of chemoradiation protocols incorporating high-dose methotrexate in the mid-1980s, but disease relapse and adverse neurocognitive sequelae remain major clinical challenges. To address this, investigators have focused on improving drug therapy with novel cytotoxic combinations, monoclonal antibody therapy, and intensive chemotherapy consolidation approaches, in an attempt to improve disease control whilst reducing the requirement for whole-brain radiotherapy. Outcomes for patients that are older, immunocompromised, or have relapsed/refractory disease remain unsatisfactory and there is a paucity of clinical trial data to guide treatment of these groups. This review highlights recent advances in pathobiology, imaging, and clinical management of PCNSL and looks ahead to research priorities for this rare and challenging lymphoid malignancy.

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Section: Treatmentmentioning

confidence: 99%

Primary CNS Lymphoma

Phillips

Fox

Cwynarski

2014

Curr Hematol Malig Rep

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“…Several studies have evaluated either calendar period [15,27] or HAART use [16–18,23,40] as prognostic factors. Building on our previous work, this is the first study to independently evaluate calendar period and individual HAART data in strictly defined AR-PCNSL cases.…”

Section: Discussionmentioning

confidence: 99%

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

Uldrick

Pipkin

Scheer

et al. 2014

Aids

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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.

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“…[55,57,58] A German study of non-HIV-related PCNSL showed no advantage of radiotherapy combined with methotrexate over methotrexate alone, [58] while a Japanese study of HIV-associated PCNSL reported prolonged survival with radiotherapy combined with HAART. [57] Meanwhile, ganciclovir has been shown to prolong survival and eradicate CSF EBV. [59] Chemotherapy and radiotherapy are both associated with major side effects, including leucopenia, liver toxicity, and leukoencephalopathy.…”

Section: Central Nervous System Lymphoma and Other Tumorsmentioning

confidence: 99%

“…[59] Chemotherapy and radiotherapy are both associated with major side effects, including leucopenia, liver toxicity, and leukoencephalopathy. [57,58] Irrespective of treatment regimen, better performance status at diagnosis improves survival. [57,58] Taking all these into consideration, patients with HIV-associated PCNSL should probably all receive a combination of HAART, ganciclovir, and methotrexate.…”

Section: Central Nervous System Lymphoma and Other Tumorsmentioning

confidence: 99%

“…[57,58] Irrespective of treatment regimen, better performance status at diagnosis improves survival. [57,58] Taking all these into consideration, patients with HIV-associated PCNSL should probably all receive a combination of HAART, ganciclovir, and methotrexate. Additional treatment with radiotherapy is then offered to those with a good performance status.…”

Section: Central Nervous System Lymphoma and Other Tumorsmentioning

confidence: 99%

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NeuroAIDS in sub-Saharan Africa: A clinical review

et al. 2013

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NeuroAIDS affects half of the 22 million people currently living with HIV/AIDS in sub-Saharan Africa, where cryptococcal meningitis alone is responsible for 504,000 deaths annually. A good understanding of NeuroAIDS may help improve disease-free survival in patients at risk and optimize resource utilization by caregivers. In this review, we aimed to provide a summary of major NeuroAIDS syndromes of relevance in Africa. We searched Medline for English language literature to identify relevant publications, using the search terms "NeuroAIDS" and "HIV AND nervous system." The most common NeuroAIDS syndrome is HIV-associated neurocognitive disorders (HAND), which affects over 1.5 million Africans yearly. While incidence of HAND has decreased with the use of highly active antiretroviral therapy, prevalence has increased due to longer life expectancy. Other NeuroAIDS syndromes include tuberculous meningitis and intracerebral tuberculoma, cryptococcal meningitis, toxoplasma encephalitis, progressive multifocal leukoencephalopathy, primary central nervous system lymphoma, stroke, and distal sensory polyneuropathy. NeuroAIDS care and research in Africa are hindered by resource limitations. Inadequate neuroimaging and laboratory facilities result in diagnostic delays and confusion, while limited access to drugs leads to inappropriate treatment. However, the situation may be improving. Better funding of HIV care by African governments and donor agencies have resulted in decreasing HIV prevalence and prolonged survival. Yet, central nervous system opportunistic infections remain important causes of death and disability among African patients with HIV/AIDS. There is the need for additional funding to improve access to antibiotics and to facilitate further research into NeuroAIDS and its treatment.

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Whole brain radiation alone produces favourable outcomes for AIDS‐related primary central nervous system lymphoma in the HAART era

Cited by 22 publications

References 27 publications

Primary CNS Lymphoma

Primary CNS Lymphoma

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

NeuroAIDS in sub-Saharan Africa: A clinical review

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