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

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 patt ern of neurologic manifestation of lymphoma in a cohort of HN-infected indi viduals with systemic NHL. METHODS. Sixty-two patients with HIV-associated systemic NHL received infus ional cyclophosphamide, doxorubicin, and etoposide. Five patients with lymp homatous meningitis at presentation received whole brain radiation therapy plus intrathecal chemotherapy (ITC). Of the remaining 57 patients, prophyla ctic ITC was recommended only for those patients with lymphomatous bone mar row involvement and/or high grade histology (N = 31), RESULTS, Thirteen patients (21%) had histologically documented (N = 6) or p resumed (N = 7) central nervous system involvement, including 7 patients (1 1%) with meningeal lymphoma discovered either at presentation (N = 5) or so on after diagnosis (N = 2), and 6 patients (10%) with cerebral mass lesions at the time of disease recurrence consistent with parenchymal brain involv ement. Five of six parenchymal brain recurrences occurred in the setting of progressive systemic disease. Four of 7 patients (57%) with meningeal lymp homa detected at presentation (N = 5) or within 3 months of presentation (N = 2) responded to therapy and survived > 1 year. Of the 26 patients assign ed to receive no prophylactic ITC, no patient developed an isolated meninge al recurrence and 1 patient developed an isolated parenchymal brain recurre nce. CONCLUSIONS. The findings of the current study suggest that in patients wit h HIV-associated systemic lymphoma, meningeal lymphoma is potentially curab le, parenchymal brain recurrence usually occurs in the setting of uncontrol led systemic disease, and prophylactic ITC may not be necessary for patient s with intermediate grade histology and uninvolved bone marrow. (C) 1999 Am erican Cancer Society.