EVALUATION OF CEREBROSPINAL-FLUID EBV-DNA AND IL-10 AS MARKERS FOR IN-VIVO DIAGNOSIS OF AIDS-RELATED PRIMARY CENTRAL-NERVOUS-SYSTEM LYMPHOMA

Acquired immunodeficiency syndrome (AIDS)-related primary central nerv ous system lymphoma (PCNSL) is almost always associated with the Epste in-Barr virus (EBV), and EBV-DNA in cerebrospinal fluid (CSF) has been indicated as a useful tumour marker for this HIV-related neoplasm. AI DS lymphomas also show an enhanced production of IL-10 which is genera lly associated with the presence of EBV in lymphoma cells. We performe d a prospective study in 19 HIV seropositive patients with brain mass lesions. and in 21 other AIDS patients with or without other neurologi cal disorders, to assess the in vivo diagnostic value of EBV-DNA and o f IL-10 levels in the CSF for primary lymphoma of the central nervous system (CNS). EBV-DNA was detected by a nested polymerase chain reacti on (PCR) in the CSF from seven of eight patients with PCNSL, diagnosed by brain biopsy (87 . 5% sensitivity) and in none of the 11 controls with brain mass lesions (100% specificity) and of the other 21 AIDS pa tients with or without neurological disorders. The only patient with P CNSL without detectable EBV-DNA in the CSF was also negative for EBV-D NA in the lymphoma tissue, whereas the samples of the other seven brai n lymphomas were all positive for EBV-DNA by nested PCR, Therefore 100 % of patients with an EBV-positive primary CNS lymphoma had detectable EBV-DNA in the CSF, No patient from the control group without PCNSL w ith EBV-negative CSF developed a lymphoma after a mean follow-up of 15 7 +/- 173 d. IL-10 levels in the CSP from the patients with PCNSL were not significantly different from those in the other groups of patient s with AIDS. Due to uniformly high levels in the CSF from AIDS patient s, IL-10 is not a useful diagnostic marker for AIDS-related brain lymp homa. The detection of EBV-DNA from the CSF by nested PCR is an extrem ely sensitive and specific diagnostic tool for AIDS-related PCNSL and should be further evaluated as a possible alternative in patients from whom brain biopsy is not advisable.