Factors associated with survival among patients with AIDS-related primary central nervous system lymphoma

Uldrick, Thomas S.a; Pipkin, Sharonb; Scheer, Susanb; Hessol, Nancy A.c

AIDS:
doi: 10.1097/QAD.0000000000000030
Epidemiology and Social
Abstract

Objective: AIDS-related primary central nervous system lymphoma (AR-PCNSL) has a poor prognosis. Improved understanding of specific patient, infectious, diagnostic, and treatment-related factors that affect overall survival (OS) is required to improve outcomes.

Design: Population-based registry linkage study.

Methods: Adult cases from the San Francisco AIDS registry (1990–2000) were matched with the California Cancer Registry (1985–2002) to ascertain AR-PCNSL data. Survival time was assessed through 31 December 2007. Risk factors and temporal trends for death were measured using two-sided Kaplan–Meier and Cox analyses.

Results: Two hundred and seven AR-PCNSL patients were identified: 68% were white, 20% Hispanic, 10% African–American, and 2% Asian. Nineteen percent of patients had central nervous system (CNS) opportunistic infections diagnosed prior to AR-PCNSL. Fifty-seven percent of patients received radiation and/or chemotherapy and 12% used HAART prior to or within 30 days of AR-PCNSL diagnosis. One hundred and ninety-nine patients died (34 deaths/100 person-years). In adjusted analysis, prior CNS opportunistic infection diagnosis increased risk of death (hazard ratio 1.9, P = 0.0006) whereas radiation and/or chemotherapy decreased risk (hazard ratio 0.6, P < 0.0001). AR-PCNSL diagnosis 1999–2002 had a lower mortality risk (hazard ratio = 0.4, P = 0.02) compared to 1990–1995. African–Americans had an increased risk of death compared to whites or Asians (hazard ratio = 2.0, P = 0.007).

Conclusion: OS among AR-PCNSL patients improved over time but remains poor, especially among African–Americans. Prospective evaluation of curative therapy in AR-PCNSL is urgently needed. Accurate diagnosis of CNS mass lesions in patients with AIDS is required and for those with AR-PCNSL, antiretroviral therapy with concomitant AR-PCNSL therapy, and antimicrobial supportive care may improve OS.

Author Information

aHIV & AIDS Malignancy Branch, Center for Cancer Research, National Cancer Institute at the National Institutes of Health, Bethesda, Maryland

bSan Francisco Department of Public Health

cDepartments of Clinical Pharmacy & Medicine, University of California, San Francisco, California, USA.

Correspondence to Thomas S. Uldrick, MD, MS, 10 Center Drive, Room 6N106, MSC 1868, Bethesda, MD 20892-1868, USA. Tel: +1 301 402 6296; fax: +1 301 480 5955; e-mail: uldrickts@mail.nih.gov

Received 27 June, 2013

Accepted 14 August, 2013

© 2014 Lippincott Williams & Wilkins, Inc.