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Barta SK , Joshi J , Mounier N , Xue X , Wang D , Ribera JM , Navarro JT , Hoffmann C , Dunleavy K , Little RF , Wilson WH , Spina M , Galicier L , Noy A , Sparano JA
Central nervous system involvement in AIDS-related lymphomas
Br J Haematol. 2016 Apr 7;173(6) :857-66
PMID: 27062389    PMCID: PMC4900917    URL: http://www.ncbi.nlm.nih.gov/pubmed/27062389
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Abstract
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 (CNSB ) and relapse (CNSR ) in 886 patients with newly diagnosed ARL. Of 886 patients, 800 received either intrathecal (IT) therapy for CNSB or IT prophylaxis. CNSB was found in 13%. CNSB was not associated with reduced overall survival (OS). There was no difference in the prevalence of CNSB between the pre-combination antiretroviral therapy (cART) and cART eras. 5.3% of patients experienced CNSR at a median of 4.2 months after diagnosis (12% if CNSB ; 4% if not). Median OS after CNSR was 1.6 months. On multivariate analysis, only CNSB [hazard ratio (HR) 3.68, P = 0.005] and complete response to initial therapy (HR 0.14, P < 0.0001) were significantly associated with CNSR . When restricted to patients without CNSB , IT CNS prophylaxis with 3 vs. 1 agent did not significantly impact the risk of CNSR . Despite IT CNS prophylaxis, 5% of patients experienced CNSR . Our data confirms that CNSR in ARL occurs early and has a poor outcome. Complete response to initial therapy was associated with a reduced frequency of CNSR . Although CNSB conferred an increased risk for CNSR , it did not impact OS.
Notes
1365-2141 Barta, Stefan K Joshi, Jitesh Mounier, Nicolas Xue, Xiaonan Wang, Dan Ribera, Josep-Maria Navarro, Jose-Tomas Hoffmann, Christian Dunleavy, Kieron Little, Richard F Wilson, Wyndham H Spina, Michele Galicier, Lionel Noy, Ariela Sparano, Joseph A K12 CA132783/CA/NCI NIH HHS/United States KL2 RR025749/RR/NCRR NIH HHS/United States TL1 RR025748/RR/NCRR NIH HHS/United States U01 CA121947/CA/NCI NIH HHS/United States UL1 RR025750/RR/NCRR NIH HHS/United States Journal article Br J Haematol. 2016 Apr 7. doi: 10.1111/bjh.13998.