Long survival in patients with acquired immune deficiency syndrome-related primary central nervous system lymphoma

Chamberlain' recently reported that 4 of approximately 40 patients with acquired immune deficiency syndrome (AIDS)related primary central nervous system non-Hodgkin's lymphoma (NHL) may have long term survival, ranging from 11 to 16 months with a median of 13.5 months, when treated with radiation therapy and chemotherapy.To evaluate this possibility in AIDS-related systemic NHL, we evaluated 73 patients with HIV infection and systemic NHL observed at the Centro di Riferimento Oncologico of Aviano, Italy, from April 1985 to February 1993.We identified 2 subgroups.The first (group A) includes patients with a complete remission (CR) lasting for at least 2 years (n = 13), and the second (group B) includes the remaining patients (n = 60).Patients who received more aggressive therapy (the LNH-842 and the cyclophosphamide, doxorubicin, teniposide, prednisone, vincristine, and bleomycin regimens) and those who received more conservative therapy (a 50% reduced dose of cyclophosphamide, doxorubicin, teniposide, prednisone, vincristine, and bleomycin and other regimens) were evenly distributed between group's A and B. Radiation therapy was given to selected patients after chemotherapy.Zidovudine (250 mg orally twice a day) was given concomitantly with or subsequently to chemotherapy to almost all patients.Of the patients' characteristics related to both NHL and human immunodeficiency viral (HIV) infection, a better performance status and higher mean CD4+ cell count at the time of NHL diagnosis were found to be statistically significantly different ( P = 0.03 and P = 0.006, respectively) in group A versus B. There was no statistically significant difference in the distribution of the stages and the histologic categories within the 2 groups of patients, although the proportion of small noncleaved cell and Ki-1 anaplastic large cell lymphomas in group A was higher than that found in group B. Conversely, large cell immunoblastic lymphomas were relatively common in group B, whereas only 1 of the 13 (8%) NHLs in group A showed this subtype.The Epstein-Barr virus study made by EBER (Epstein-Barr virus encoded RNA) did not find any difference in the two groups of patients, with approximately 50% of cases being Epstein-Barr virus-associated.Overall, the