Treatment outcome in presumed and confirmed AIDS-related primary cerebral lymphoma

A retrospective analysis identified 38 HIV seropositive patients with a dia gnosis of presumed (n = 26) or confirmed (n = 12) primary cerebral lymphoma (PCNSL). All patients had failed to respond to empirical antitoxoplasma th erapy and the clinical diagnosis of PCNSL was confirmed by brain biopsy (n = 4), cerebrospinal fluid (CSF) examination for Epstein-Barr virus (EBV) by PCR (n = 7) or postmortem examination (n = 1). There was no difference in the age, performance status, CD4 counts, antiretroviral usage or interval s ince first HIV serodiagnosis between patients with presumed or confirmed PC NSL. 16 patients received either radiotherapy (n = 14) or chemotherapy (n = 2). Patients with confirmed or presumptive PCNSL were equally likely to re ceive treatment. The median overall survival, which was measured from the e nd of unsuccessful antitoxoplasma therapy, was 1.2 months for the whole coh ort. There was no difference in overall survival between patients with pres umptive (median 0.8 months) and confirmed (median 1.3 months) PCNSL (logran k P = 0.69). This suggests that there may be little value in positively dia gnosing PCNSL in the current diagnostic algorithm. Recent improvements in o utcome have been reported with systemic chemotherapy in HIV-PCNSL and may i nfluence the need for earlier definitive diagnosis in the future. (C) 1999 Elsevier Science Ltd. All rights reserved.