Antiviral and immunomodulatory treatment for AIDS-related primary central nervous system lymphoma: AIDS malignancies consortium pilot study 019

David M. Aboulafia, Lee Ratner, Steven A. Miles, William J. Harrington

Research output: Contribution to journalArticlepeer-review

34 Scopus citations

Abstract

Purpose: A consistent association with Epstein-Barr Virus (EBV) distinguishes acquired immunodeficiency syndrome (AIDS)-related primary central nervous system lymphoma (PCNSL) from that which occurs in the general population. Recent descriptions of long-term remissions in patients with posttransplantation EBV-associated PCNSL who received EBV-specific therapy suggest some antitumor effect is anti-EBV mediated. Patients and methods: We enrolled 4 patients with AIDS-related PCNSL in to a novel antiviral and immunomodulatory protocol. An additional patient was treated in a similar fashion off protocol. Treatment consisted of intravenously administered zidovudine (1.5 g twice daily), ganciclovir (5 mg/kg twice daily), and interleukin-2 (2,000,000 U twice daily). After 2 weeks of therapy, patients were switched to oral ganciclovir (1 g 3 times daily), patient-specific, highly active, antiretroviral therapy, and subcutaneous interleukin-2 (2,000,000 U 3 times weekly). A final patient was treated with intravenous zidovudine and hydroxyurea. All 6 patients had advanced-stage AIDS as reflected by a CD4+ T-lymphocyte cell count of < 50/μL and a detectable human immunodeficiency virus (HIV)-1 viral RNA load (median copies, 135,000/mL; range, 2170-360,000/mL). One of 4 protocol-enrolled patients remains in complete remission with > 4 years' follow-up. Results: Three patients died from complications of progressive PCNSL. Two patients treated off protocol exhibited favorable responses and remain in complete remission at 28 months and 52 months, respectively. Grade 3/4 myelosuppression was uniformly noted, but there were no clinically significant hemorrhagic or infectious complications. Conclusion: We conclude that for patients with AIDS and PCNSL, treatments with dual efficacy against HIV and EBV merit further investigation. Our experience provides a platform for future studies.

Original languageEnglish
Pages (from-to)399-402
Number of pages4
JournalClinical Lymphoma and Myeloma
Volume6
Issue number5
DOIs
StatePublished - Mar 2006

Keywords

  • Antiretroviral therapy
  • Central nervous system lesions
  • Ganciclovir
  • Human immunodeficiency virus
  • Interleukin-2
  • Zidovudine

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