Treatment of AIDS-related primary central nervous system lymphoma with zidovudine, ganciclovir, and interleukin 2

AIDS-related primary central nervous system lymphoma (AIDS PCNSL) is a rapi dly fatal disease. Conventional therapeutic modalities offer little and new approaches are needed. Previous work has shown that zidovudine (AZT) in co mbination with other agents is active in retroviral lymphomas, Epstein-Barr virus (EBV) is detected in tumor tissue and cerebrospinal fluid of AIDS PC NSL patients. In a preliminary in vitro study we found that an Epstein-Barr virus-positive B cell line underwent apoptosis on coculture with AZT, This effect was accentuated by the addition of ganciclovir (GCV). We treated fi ve patients with AIDS PCNSL with a regimen consisting of parenteral zidovud ine (1.6 g twice daily), ganciclovir (5 mg/kg twice daily), and interleukin 2 (2 million units twice daily), Four of five had an excellent response. T wo patients are alive and free of disease 22 and 13 months later; another r esponded on two separate occasions, 5 months apart, and the last patient re sponded with a 70-80% regression of tumor but could not be maintained on th erapy owing to myelosuppression, We conclude that parenteral zidovudine, ga nciclovir, and interleukin 2 is an active combination for AIDS-related cent ral nervous system lymphoma.