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HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma: Treatment & Medication
Updated: May 8, 2007
- Overview
- Differential Diagnoses & Workup
- Treatment & Medication
- Follow-up
- Multimedia
Treatment
Medical Care
No consensus exists on treatment. Few studies have addressed the management of HIV-associated CNS lymphoma, and most algorithms were formulated based on protocols in immunocompetent individuals.
- HAART and cranial radiation increase survival.
- Adult dose is fractionated 4000-5000 cGy. This results in clinical improvement and radiographic regression of the lesions.
- Based on the consistent association of EBV with HIV-associated CNS lymphoma, antiviral and immunomodulatory treatment are being tried.
- Treatment with ganciclovir was associated with increased survival and undetectable CSF EBV DNA load.4
- In a prospective study using high-dose ganciclovir and IL-2, 1 of 4 patients had complete remission.5
- The CNS is a sanctuary site for lymphoma and can be a barrier to cure. CNS prophylaxis is recommended for all patients with HIV-associated lymphoma, even those without current clinical CNS involvement.
- Little data exist to support the use of steroids.
Medication
HAART with radiation is the mainstay of treatment.
Based on the study by Bossolasco et al, ganciclovir is associated with increased survival and undetectable EBV DNA load in CSF.4
Anecdotal reports are known of responses to systemic and intrathecal methotrexate (3 g/m2 q14d with leucovorin rescue), thiotepa, and procarbazine. No dosage recommendations can be given at this time.
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| Overview: HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma |
| Differential Diagnoses & Workup: HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma |
Treatment & Medication: HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma |
| Follow-up: HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma |
| Multimedia: HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma |
| References |
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References
Wolf T, Brodt HR, Fichtlscherer S. Changing incidence and prognostic factors of survival in AIDS-related non-Hodgkin's lymphoma in the era of highly active antiretroviral therapy (HAART). Leuk Lymphoma. Feb 2005;46(2):207-15. [Medline].
Biggar RJ, Engels EA, Ly S. Survival after cancer diagnosis in persons with AIDS. J Acquir Immune Defic Syndr. Jul 1 2005;39(3):293-9. [Medline].
Skiest DJ, Crosby C. Survival is prolonged by highly active antiretroviral therapy in AIDS patients with primary central nervous system lymphoma. AIDS. Aug 15 2003;17(12):1787-93. [Medline].
Bossolasco S, Falk KI, Ponzoni M. Ganciclovir is associated with low or undetectable Epstein-Barr virus DNA load in cerebrospinal fluid of patients with HIV-related primary central nervous system lymphoma. Clin Infect Dis. Feb 15 2006;42(4):e21-5. [Medline].
Aboulafia DM, Ratner L, Miles SA. Antiviral and immunomodulatory treatment for AIDS-related primary central nervous system lymphoma: AIDS Malignancies Consortium pilot study 019. Clin Lymphoma Myeloma. Mar 2006;6(5):399-402. [Medline].
AAN Quality Standards Subcommittee. Evaluation and management of intracranial mass lesions in AIDS. Report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. Jan 1998;50(1):21-6. [Medline].
de Gans J, Portegies P. Neurological complications of infection with human immunodeficiency virus type 1. A review of literature and 241 cases. Clin Neurol Neurosurg. 1989;91(3):199-219. [Medline].
Forsyth PA, DeAngelis LM. Biology and management of AIDS-associated primary CNS lymphomas. Hematol Oncol Clin North Am. Oct 1996;10(5):1125-34. [Medline].
Gendelman HE, Lipton SA, Epstein L. The Neurology of AIDS. New York: Chapman & Hall; 1998.
Hoffman C. Primary CNS lymphoma. In: HIV Medicine. 2005.
Noy A. Update in HIV lymphoma. Curr Opin Oncol. Sep 2006;18(5):449-55. [Medline].
Offiah CE, Turnbull IW. The imaging appearances of intracranial CNS infections in adult HIV and AIDS patients. Clin Radiol. May 2006;61(5):393-401. [Medline].
Said G, Saimont AG, Lacroix C. Neurological Complications of HIV and AIDS. Philadelphia: WB Saunders; 1998.
Singh A, Strobos RJ, Singh BM, et al. Steroid-induced remissions in CNS lymphoma. Neurology. Nov 1982;32(11):1267-71. [Medline].
Further Reading
Keywords
Acquired immunodeficiency syndrome, AIDS, HIV-associated CNS lymphoma, Epstein-Barr virus, EBV, EVB infection, toxoplasmosis, large-cell non-Hodgkin lymphoma, large-cell non-Hodgkin's lymphoma, non-Hodgkin's lymphoma, non-Hodgkin lymphoma, late complication of HIV infection, HIV infection
Treatment & Medication: HIV-1 Associated Opportunistic Neoplasms - CNS Lymphoma