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Primary central nervous system lymphoma in patients with and without HIV infection: a multicenter study and comparison with U.S national data

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Abstract

Purpose

Primary central nervous system lymphoma (PCNSL) in patients living with HIV (PLWH) is a distinct entity; however, the management is adopted from patients without HIV. The study aims to examine the differences in presentation, treatment, and outcomes of PCNSL patients with or without HIV.

Methods

We retrospectively compared the characteristics of 144 patients with PCNSL with and without HIV, and analyzed factors associated with overall and progression-free survival. Results were compared to the Central Brain Tumor Registry of the United States (CBTRUS) and the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) system.

Results

Among all patients with PCNSL, 19% had HIV. PLWH were younger (38 vs. 63 years; p < 0.01) and more likely to be African American (59% vs. 7%; p < 0.01) and male (74% vs. 49%; p = 0.02) than patients without HIV. PLWH were more likely to have multiple lesions (67% vs. 43%; p = 0.02), hemorrhage (59 vs. 37%; p = 0.03), and peripheral rim enhancement (57% vs. 7%; p < 0.01) on imaging; to receive palliative care (15% vs. 2%) or whole brain radiation (63% vs. 3%); and less likely to receive chemotherapy (22% vs. 95%) (p < 0.01). Twenty-four patients, none PLWH, underwent stem cell transplant. Not receiving transplant was an independent factor in mortality and disease progression. Our cohort of patients, compared to the national database, were younger (60 vs. 65 years), 58% were white vs. 75%, and had longer median overall survival 43 vs. 25 months.

Conclusion

Epidemiology, imaging, and treatment options for patients with PCNSL with and without HIV differ, but HIV was not an independent factor of mortality or disease progression. More efforts are needed to improve access to research and treatment options for PLWH with PCNSL.

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Acknowledgments

We thank the Department of Scientific Publications at The University of Texas MD Anderson Cancer Center for editorial assistance.

Funding

QTO is supported by a Research Training Grant from the Cancer Prevention and Research Institute of Texas (CPRIT; RP160097T). Funding for the Central Brain Tumor Registry of the United States (CBTRUS) was provided by the U.S. Centers for Disease Control and Prevention (CDC) under Contract No. 2016-M-9030, the American Brain Tumor Association, The Sontag Foundation, Novocure, AbbVie, the Musella Foundation, Alex’s Lemonade Stand Foundation, as well as private, and in-kind donations. Contents are solely the responsibility of the authors and do not necessarily reflect the official views of the CDC or the VA.

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Authors and Affiliations

  1. Department of Medicine, Division of Infectious Diseases, University of Missouri, Columbia, MO, USA

    Dima Dandachi

  2. Department of Medicine, Section of Infectious Diseases, Baylor College of Medicine, Houston, TX, USA

    Dima Dandachi, Jose A. Serpa & Thomas P. Giordano

  3. Department of Infectious Diseases, Infection Control and Employee Health, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Dima Dandachi

  4. Duncan Cancer Center, Baylor College of Medicine, Houston, TX, USA

    Quinn T. Ostrom

  5. Central Brain Tumor Registry of the United States, Hinsdale, IL, USA

    Quinn T. Ostrom, Carol Kruchko & Jill S. Barnholtz-Sloan

  6. Department of Radiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX, 77030, USA

    Insun Chong & Fanny E. Morón

  7. Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey VA Medical Center, Houston, TX, USA

    Thomas P. Giordano

  8. Case Comprehensive Cancer Center, Case Western Reserve University School of Medicine, Cleveland, OH, USA

    Jill S. Barnholtz-Sloan

  9. Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Nathan Fowler

  10. Department of Diagnostic Radiology, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rivka R. Colen

  11. Department of Cancer Systems Imaging, Division of Diagnostic Imaging, The University of Texas MD Anderson Cancer Center, Houston, TX, USA

    Rivka R. Colen

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  1. Dima Dandachi
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Correspondence to Fanny E. Morón.

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Dandachi, D., Ostrom, Q.T., Chong, I. et al. Primary central nervous system lymphoma in patients with and without HIV infection: a multicenter study and comparison with U.S national data. Cancer Causes Control 30, 477–488 (2019). https://doi.org/10.1007/s10552-019-01144-8

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  • DOI: https://doi.org/10.1007/s10552-019-01144-8

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