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

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.