590   Survival of AIDS Patients with Primary Central Nervous System Lymphoma (PCNSL) Is Dramatically Improved by HAART-Induced Immune Recovery.

C. Hoffmann*¹, S. Tabrizian², E. Wolf¹, T. Buhk³, C. Eggers³, H. J. Stellbrink³, A. Stoehr², A. Plettenberg², H. A. Horst⁴, E. Jaegel-Guedes¹, H. Jaeger¹, and T. Rosenkranz².
¹Curatorium for Immunodeficiency, Munich;²St. Georg Hosp., Hamburg;³Univ. Clin. Eppendorf, Hamburg; and⁴Christian-Albrechts-Univ., Kiel, Germany.

Background:PCNSL represents a late complication of HIV infection. AIDS patients (pts.) with PCNSL usually have a dismal prognosis and a median survival of less than three months. In this setting, only few data exist concerning the role of the immune recovery achieved by highly active antiretroviral therapy (HAART).

Methods:Multicentric, retrospective analysis of 27 HIV⁺patients (25 males) with PCNSL histologically confirmed between 1990—2000. Medical records were abstracted for age, clinical and radiological features, histological diagnosis, CD4 counts, viral load (VL), AIDS history, cranial radiation (CR) and ART. To evaluate median survival in subgroups, Kaplan-Meier statistics were used. To explore the effects of several variables on survival, we performed a Cox proportional hazard regression analysis.

Results:Mean age at manifestation of PCNSL was 42.2 years. Median CD4 count was 12/mm³(range 0—180), median VL was 403,500 copies/ml, and 76 % of pts. had a prior AIDS-defining illness. The most frequent histological diagnosis was immunoblastic plasmocytoid lymphoma (44%), and multiple lesions were found in 42%. CR (30—50 Gy) was given to 11/27 pts. On manifestation of PCNSL, 19/27 pts. stopped or had never received any ART, and two pts. continued dual ART (group A). Six pts. were treated with HAART (group B). In group B, median survival following the onset of symptoms was 1093 days (range 55—1588 days), compared to 53 days in group A (range 14—333 days, p = 0.0004, log rank test). In the Cox model, the only factors associated with prolonged survival were HAART (relative hazard (RH) 0.08; 95% CI: 0.01—0.75; p = 0.027) and CR (RH 0.27; CI: 0.08—0.89, p = 0.032). Four pts. in group B survived more than one year, with three still being alive. All four pts. showed a marked immune recovery, with a mean CD4 increase of 342/mm³.

Conclusion:Data from this cohort indicate that immune recovery induced by HAART leads to dramatic improvement of survival in patients with AIDS-associated PCNSL.