Primary CNS lymphoma in HIV-positive and -negative patients: Comparison of clinical characteristics, outcome, and prognostic factors.

Abstract

e12502 Background: Primary central nervous system lymphoma (PCNSL) accounts for approximately 4% of all primary brain tumors and has a poor prognosis in both immunocompetent as well as in immunocompromised patients. We conducted a retrospective analysis to examine the clinical characteristics and prognostic factors in HIV-negative and positive patients with PCNSL and to assess the effect of highly active antiretroviral therapy (HAART) therapy on the outcome of HIV-positive patients. Methods: Patients diagnosed with PCNSL between 1999 and 2008 at our institution were divided into two groups based on their HIV status. Their demographic and clinical characteristics were compared using the chi-square test. Kaplan-Meier survival curves were constructed employing the univariate log-rank test. Multivariate analyses of survival were performed by Cox proportional hazards models incorporating the prognostic factors identified in the univariate log rank test. Results: Forty-one HIV-positive patients and 45 HIV-negative patients were included in the statistical analysis. HIV-positive patients were younger; more likely to present with seizures and elevated serum LDH levels. The most commonly used chemotherapy regimen in the HIV-negative group was methotrexate-based, following the DeAngelis protocol, with an overall response rate (ORR) of 73%. All HIV-positive patients were treated with azidothymidine combinations, with a cumulative ORR of 56%. There were significant differences in complete remission (CR) rates (p = 0.010) and overall survival (OS) (p = 0.034) in favor of the HIV-negative group. In the HIV-positive group, OS was better in patients with KPS > 70 and patients who received HAART, but remained inferior to that in the HIV-negative patients. Moreover, in patients who were not on HAART before PCNSL diagnosis, initiation of HAART was associated with better OS (4.0 vs. 1.1 months, p = 0.007). Conclusions: HIV-positive patients had a worse prognosis compared to HIV-negative patients despite similar clinical characteristics. Better performance status (KPS > 70) and treatment with HAART conferred better OS in HIV-positive patients. No significant financial relationships to disclose.