Patterns of central nervous system recurrence in patients with systemic human immunodeficiency virus-associated non-Hodgkin lymphoma

Jigna Desai, Robin J. Mitnick, David H. Henry, Josefina Llena, Joseph A. Sparano

Research output: Contribution to journalArticle

32 Citations (Scopus)

Abstract

BACKGROUND. Central nervous system involvement is a common manifestation of non-Hodgkin lymphoma (NHL) in human immunodeficiency virus (HIV)-infected individuals. The purpose of this study was to review the frequency and pattern of neurologic manifestation of lymphoma in a cohort of HIV-infected individuals with systemic NHL. METHODS. Sixty-two patients with HIV- associated systemic NHL received infusional cyclophosphamide, doxorubicin, and etoposide. Five patients with lymphomatous meningitis at presentation received whole brain radiation therapy plus intrathecal chemotherapy (ITC). Of the remaining 57 patients, prophylactic ITC was recommended only for those patients with lymphomatous bone marrow involvement and/or high grade histology (N = 31). RESULTS. Thirteen patients (21%) had histologically documented (N = 6) or presumed (N = 7) central nervous system involvement, including 7 patients (11%) with meningeal lymphoma discovered either at presentation (N = 5) or soon after diagnosis (N = 2), and 6 patients (10%) with cerebral mass lesions at the time of disease recurrence consistent with parenchymal brain involvement. Five of six parenchymal brain recurrences occurred in the setting of progressive systemic disease. Four of 7 patients (57%) with meningeal lymphoma detected at presentation (N = 5) or within 3 months of presentation (N = 2) responded to therapy and Survived > 1 year. Of the 26 patients assigned to receive no prophylactic ITC, no patient developed an isolated meningeal recurrence and 1 patient developed an isolated parenchymal brain recurrence. CONCLUSIONS. The findings of the current study suggest that in patients with HIV-associated systemic lymphoma, meningeal lymphoma is potentially curable, parenchymal brain recurrence usually occurs in the setting of uncontrolled systemic disease, and prophylactic ITC may not be necessary for patients with intermediate grade histology and uninvolved bone marrow.

Original languageEnglish (US)
Pages (from-to)1840-1847
Number of pages8
JournalCancer
Volume86
Issue number9
DOIs
StatePublished - Nov 1 1999

Fingerprint

Non-Hodgkin's Lymphoma
Central Nervous System
HIV
Recurrence
Lymphoma
Brain
Drug Therapy
Histology
Bone Marrow
Etoposide
Neurologic Manifestations
Meningitis
Doxorubicin
Cyclophosphamide
Radiotherapy

Keywords

  • Acquired immunodeficiency syndrome (AIDS)
  • Central nervous system
  • Chemotherapy
  • Human immunodeficiency virus (HIV)
  • Intrathecal
  • Meningitis
  • Non-Hodgkin lymphoma (NHL)
  • Radiation therapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Patterns of central nervous system recurrence in patients with systemic human immunodeficiency virus-associated non-Hodgkin lymphoma. / Desai, Jigna; Mitnick, Robin J.; Henry, David H.; Llena, Josefina; Sparano, Joseph A.

In: Cancer, Vol. 86, No. 9, 01.11.1999, p. 1840-1847.

Research output: Contribution to journalArticle

Desai, Jigna ; Mitnick, Robin J. ; Henry, David H. ; Llena, Josefina ; Sparano, Joseph A. / Patterns of central nervous system recurrence in patients with systemic human immunodeficiency virus-associated non-Hodgkin lymphoma. In: Cancer. 1999 ; Vol. 86, No. 9. pp. 1840-1847.
@article{7ab3a844206a4d71aca566e670d567d7,
title = "Patterns of central nervous system recurrence in patients with systemic human immunodeficiency virus-associated non-Hodgkin lymphoma",
abstract = "BACKGROUND. Central nervous system involvement is a common manifestation of non-Hodgkin lymphoma (NHL) in human immunodeficiency virus (HIV)-infected individuals. The purpose of this study was to review the frequency and pattern of neurologic manifestation of lymphoma in a cohort of HIV-infected individuals with systemic NHL. METHODS. Sixty-two patients with HIV- associated systemic NHL received infusional cyclophosphamide, doxorubicin, and etoposide. Five patients with lymphomatous meningitis at presentation received whole brain radiation therapy plus intrathecal chemotherapy (ITC). Of the remaining 57 patients, prophylactic ITC was recommended only for those patients with lymphomatous bone marrow involvement and/or high grade histology (N = 31). RESULTS. Thirteen patients (21{\%}) had histologically documented (N = 6) or presumed (N = 7) central nervous system involvement, including 7 patients (11{\%}) with meningeal lymphoma discovered either at presentation (N = 5) or soon after diagnosis (N = 2), and 6 patients (10{\%}) with cerebral mass lesions at the time of disease recurrence consistent with parenchymal brain involvement. Five of six parenchymal brain recurrences occurred in the setting of progressive systemic disease. Four of 7 patients (57{\%}) with meningeal lymphoma detected at presentation (N = 5) or within 3 months of presentation (N = 2) responded to therapy and Survived > 1 year. Of the 26 patients assigned to receive no prophylactic ITC, no patient developed an isolated meningeal recurrence and 1 patient developed an isolated parenchymal brain recurrence. CONCLUSIONS. The findings of the current study suggest that in patients with HIV-associated systemic lymphoma, meningeal lymphoma is potentially curable, parenchymal brain recurrence usually occurs in the setting of uncontrolled systemic disease, and prophylactic ITC may not be necessary for patients with intermediate grade histology and uninvolved bone marrow.",
keywords = "Acquired immunodeficiency syndrome (AIDS), Central nervous system, Chemotherapy, Human immunodeficiency virus (HIV), Intrathecal, Meningitis, Non-Hodgkin lymphoma (NHL), Radiation therapy",
author = "Jigna Desai and Mitnick, {Robin J.} and Henry, {David H.} and Josefina Llena and Sparano, {Joseph A.}",
year = "1999",
month = "11",
day = "1",
doi = "10.1002/(SICI)1097-0142(19991101)86:9<1840::AID-CNCR28>3.0.CO;2-C",
language = "English (US)",
volume = "86",
pages = "1840--1847",
journal = "Cancer",
issn = "0008-543X",
publisher = "John Wiley and Sons Inc.",
number = "9",

}

TY - JOUR

T1 - Patterns of central nervous system recurrence in patients with systemic human immunodeficiency virus-associated non-Hodgkin lymphoma

AU - Desai, Jigna

AU - Mitnick, Robin J.

AU - Henry, David H.

AU - Llena, Josefina

AU - Sparano, Joseph A.

PY - 1999/11/1

Y1 - 1999/11/1

N2 - BACKGROUND. Central nervous system involvement is a common manifestation of non-Hodgkin lymphoma (NHL) in human immunodeficiency virus (HIV)-infected individuals. The purpose of this study was to review the frequency and pattern of neurologic manifestation of lymphoma in a cohort of HIV-infected individuals with systemic NHL. METHODS. Sixty-two patients with HIV- associated systemic NHL received infusional cyclophosphamide, doxorubicin, and etoposide. Five patients with lymphomatous meningitis at presentation received whole brain radiation therapy plus intrathecal chemotherapy (ITC). Of the remaining 57 patients, prophylactic ITC was recommended only for those patients with lymphomatous bone marrow involvement and/or high grade histology (N = 31). RESULTS. Thirteen patients (21%) had histologically documented (N = 6) or presumed (N = 7) central nervous system involvement, including 7 patients (11%) with meningeal lymphoma discovered either at presentation (N = 5) or soon after diagnosis (N = 2), and 6 patients (10%) with cerebral mass lesions at the time of disease recurrence consistent with parenchymal brain involvement. Five of six parenchymal brain recurrences occurred in the setting of progressive systemic disease. Four of 7 patients (57%) with meningeal lymphoma detected at presentation (N = 5) or within 3 months of presentation (N = 2) responded to therapy and Survived > 1 year. Of the 26 patients assigned to receive no prophylactic ITC, no patient developed an isolated meningeal recurrence and 1 patient developed an isolated parenchymal brain recurrence. CONCLUSIONS. The findings of the current study suggest that in patients with HIV-associated systemic lymphoma, meningeal lymphoma is potentially curable, parenchymal brain recurrence usually occurs in the setting of uncontrolled systemic disease, and prophylactic ITC may not be necessary for patients with intermediate grade histology and uninvolved bone marrow.

AB - BACKGROUND. Central nervous system involvement is a common manifestation of non-Hodgkin lymphoma (NHL) in human immunodeficiency virus (HIV)-infected individuals. The purpose of this study was to review the frequency and pattern of neurologic manifestation of lymphoma in a cohort of HIV-infected individuals with systemic NHL. METHODS. Sixty-two patients with HIV- associated systemic NHL received infusional cyclophosphamide, doxorubicin, and etoposide. Five patients with lymphomatous meningitis at presentation received whole brain radiation therapy plus intrathecal chemotherapy (ITC). Of the remaining 57 patients, prophylactic ITC was recommended only for those patients with lymphomatous bone marrow involvement and/or high grade histology (N = 31). RESULTS. Thirteen patients (21%) had histologically documented (N = 6) or presumed (N = 7) central nervous system involvement, including 7 patients (11%) with meningeal lymphoma discovered either at presentation (N = 5) or soon after diagnosis (N = 2), and 6 patients (10%) with cerebral mass lesions at the time of disease recurrence consistent with parenchymal brain involvement. Five of six parenchymal brain recurrences occurred in the setting of progressive systemic disease. Four of 7 patients (57%) with meningeal lymphoma detected at presentation (N = 5) or within 3 months of presentation (N = 2) responded to therapy and Survived > 1 year. Of the 26 patients assigned to receive no prophylactic ITC, no patient developed an isolated meningeal recurrence and 1 patient developed an isolated parenchymal brain recurrence. CONCLUSIONS. The findings of the current study suggest that in patients with HIV-associated systemic lymphoma, meningeal lymphoma is potentially curable, parenchymal brain recurrence usually occurs in the setting of uncontrolled systemic disease, and prophylactic ITC may not be necessary for patients with intermediate grade histology and uninvolved bone marrow.

KW - Acquired immunodeficiency syndrome (AIDS)

KW - Central nervous system

KW - Chemotherapy

KW - Human immunodeficiency virus (HIV)

KW - Intrathecal

KW - Meningitis

KW - Non-Hodgkin lymphoma (NHL)

KW - Radiation therapy

UR - http://www.scopus.com/inward/record.url?scp=0033229751&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0033229751&partnerID=8YFLogxK

U2 - 10.1002/(SICI)1097-0142(19991101)86:9<1840::AID-CNCR28>3.0.CO;2-C

DO - 10.1002/(SICI)1097-0142(19991101)86:9<1840::AID-CNCR28>3.0.CO;2-C

M3 - Article

C2 - 10547559

AN - SCOPUS:0033229751

VL - 86

SP - 1840

EP - 1847

JO - Cancer

JF - Cancer

SN - 0008-543X

IS - 9

ER -