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Patterns of central nervous system recurrence in patients with systemic human immunodeficiency virus‐associated non‐Hodgkin lymphoma
Author(s) -
Desai Jigna,
Mitnick Robin J.,
Henry David H.,
Llena Josefina,
Sparano Joseph A.
Publication year - 1999
Publication title -
cancer
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.052
H-Index - 304
eISSN - 1097-0142
pISSN - 0008-543X
DOI - 10.1002/(sici)1097-0142(19991101)86:9<1840::aid-cncr28>3.0.co;2-c
Subject(s) - medicine , lymphoma , systemic disease , chemotherapy , pathology , parenchyma , cyclophosphamide , disease
BACKGROUND Central nervous system involvement is a common manifestation of non‐Hodgkin lymphoma (NHL) in human immunodeficiency virus (HIV)‐infected individuals. The purpose of this study was to review the frequency and pattern of neurologic manifestation of lymphoma in a cohort of HIV‐infected individuals with systemic NHL. METHODS Sixty‐two patients with HIV‐associated systemic NHL received infusional cyclophosphamide, doxorubicin, and etoposide. Five patients with lymphomatous meningitis at presentation received whole brain radiation therapy plus intrathecal chemotherapy (ITC). Of the remaining 57 patients, prophylactic ITC was recommended only for those patients with lymphomatous bone marrow involvement and/or high grade histology (N = 31). RESULTS Thirteen patients (21%) had histologically documented (N = 6) or presumed (N = 7) central nervous system involvement, including 7 patients (11%) with meningeal lymphoma discovered either at presentation (N = 5) or soon after diagnosis (N = 2), and 6 patients (10%) with cerebral mass lesions at the time of disease recurrence consistent with parenchymal brain involvement. Five of six parenchymal brain recurrences occurred in the setting of progressive systemic disease. Four of 7 patients (57%) with meningeal lymphoma detected at presentation (N = 5) or within 3 months of presentation (N = 2) responded to therapy and survived > 1 year. Of the 26 patients assigned to receive no prophylactic ITC, no patient developed an isolated meningeal recurrence and 1 patient developed an isolated parenchymal brain recurrence. CONCLUSIONS The findings of the current study suggest that in patients with HIV‐associated systemic lymphoma, meningeal lymphoma is potentially curable, parenchymal brain recurrence usually occurs in the setting of uncontrolled systemic disease, and prophylactic ITC may not be necessary for patients with intermediate grade histology and uninvolved bone marrow. Cancer 1999;86:1840–7. © 1999 American Cancer Society.