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Central nervous system involvement in AIDS ‐related lymphomas
Author(s) -
Barta Stefan K.,
Joshi Jitesh,
Mounier Nicolas,
Xue Xiaonan,
Wang Dan,
Ribera JosepMaria,
Navarro JoseTomas,
Hoffmann Christian,
Dunleavy Kieron,
Little Richard F.,
Wilson Wyndham H.,
Spina Michele,
Galicier Lionel,
Noy Ariela,
Sparano Joseph A.
Publication year - 2016
Publication title -
british journal of haematology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.907
H-Index - 186
eISSN - 1365-2141
pISSN - 0007-1048
DOI - 10.1111/bjh.13998
Subject(s) - central nervous system , medicine , cart , hazard ratio , immunology , confidence interval , mechanical engineering , engineering
Summary Central nervous system ( CNS ) involvement is reportedly more common in acquired immunodeficiency syndrome ( AIDS )‐related lymphomas ( ARL ). We describe factors and outcomes associated with CNS involvement at baseline ( CNS B ) and relapse ( CNS R ) in 886 patients with newly diagnosed ARL . Of 886 patients, 800 received either intrathecal ( IT ) therapy for CNS B or IT prophylaxis. CNS B was found in 13%. CNS B was not associated with reduced overall survival ( OS ). There was no difference in the prevalence of CNS B between the pre‐combination antiretroviral therapy ( cART ) and cART eras. 5·3% of patients experienced CNS R at a median of 4·2 months after diagnosis (12% if CNS B ; 4% if not). Median OS after CNS R was 1·6 months. On multivariate analysis, only CNS B [hazard ratio ( HR ) 3·68, P = 0·005] and complete response to initial therapy ( HR 0·14, P < 0·0001) were significantly associated with CNS R . When restricted to patients without CNS B , IT CNS prophylaxis with 3 vs. 1 agent did not significantly impact the risk of CNS R . Despite IT CNS prophylaxis, 5% of patients experienced CNS R . Our data confirms that CNS R in ARL occurs early and has a poor outcome. Complete response to initial therapy was associated with a reduced frequency of CNS R . Although CNS B conferred an increased risk for CNS R , it did not impact OS.