Central nervous system involvement in AIDS-related lymphomas

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.