• AIDS-Related Primary Central Nervous System Lymphoma

    AIDS-Related Primary CNS Lymphoma

    Definition

    Lymphomas are cancers of the lymph system. The lymph system has a series of nodes, channels, and tissue throughout the body. The lymph creates and carries white blood cells that fight infections in the body. Lymphoma starts in these white blood cells.
    Primary central nervous system (CNS) lymphomas are cancers of the lymph tissue that develop in the brain and/or spinal cord. AIDS-related primary CNS lymphoma is one that develops in people with HIV. If someone with HIV develops lymphoma, it is one of many complications that show that AIDS has developed.
    There are different types of lymphoma. AIDS-related primary CNS lymphoma is a type of non-Hodgkin's lymphoma (NHL). NHL does develop in people without AIDS, but AIDS-related lymphoma can be more aggressive.
    The Lymphatic System
    IMAGE
    Copyright © Nucleus Medical Media, Inc.

    Causes

    Cancer occurs when cells in the body divide without control or order. If cells keep dividing uncontrollably, a mass of tissue forms, called a growth or tumor. Primary CNS begins in lymph tissue of the brain. Some types of lymphoma can start in other areas of the body and spread to the brain, this is called secondary CNS lymphoma. It requires different treatment.
    Lymphoma starts because of damage to the DNA when a new white blood cell is created. The damaged DNA instructs the cells to divide and grow abnormally. The damaged cell may then split and create new damaged cells. It is not clear what causes this change to DNA but it may be a combination of genetic and environmental factors.

    Risk Factors

    Having HIV infection increases the risk of AIDS-related primary CNS lymphoma.
    HIV damages the white blood cells in the body. The body will try to create more white blood cells to make up for the damaged cells. This may result in the increased creation of another type of white blood cell that develops into lymphoma.
    HIV also lowers the immune system in general making people more vulnerable to cancer.

    Symptoms

    Symptoms will depend on where a growth or swelling is occurring. Growths can put pressure on nearby areas of the brain, nerves, or spinal cord which can cause:
    • Nausea and vomiting
    • Limb weakness or pain
    • Headaches
    • Hearing or vision problems
    • Back pain
    • Seizures
    • Difficulty swallowing
    • Difficulty controlling the flow of urine
    • Changes in mental status
    • Paralysis

    Diagnosis

    You will be asked about your symptoms and medical history. A physical exam will be done. An assessment of the nervous system or an eye exam may also be done if there are relevant symptoms.
    Evidence of the lymphoma can also be found in blood and fluid surrounding the spine and brain. This can be done with:
    If a tumor is located a small sample of the tumor, biopsy, will be taken and closely examined.
    Tests may be done to determine the stage of the cancer. Staging is a careful attempt to determine whether the cancer has spread and, if it has, what body parts are affected.
    Images of the spine and brain may also be taken to locate tumors and damage to nearby tissue. Images can be taken with:

    Treatment

    Treatment depends on the type, aggressiveness, and stage of the cancer. Treatment for AIDS will start or continue as well.
    Cancer treatments can further weaken the immune system so it is important to manage AIDS and keep the immune system as strong as possible. Treatment for AIDS includes highly active antiretroviral therapy (HAART). These medications can help slow the progression of AIDS and improve the immune system. Changes may be needed to the AIDS medications if chemotherapy is started to prevent interactions.
    Treatment for the lymphoma may include:

    Chemotherapy and Radiation Therapy

    Chemotherapy involves the use of drugs to kill cancer cells. The drugs enter the bloodstream and travel through the body. While chemotherapy is focused on killing cancer cells, some healthy cells are affected as well. The impact on the healthy cells can cause a range of side effects.
    Chemotherapy is a common choice of treatment for lymphoma because it can affect cells all over the body. This therapy is often delivered over a number of cycles with a few weeks of rest after a few days of treatment.
    Radiation therapy is the delivery of radioactive material to a specific area. The radiation disrupts the DNA in the cancer cells to stop them from growing and creating more cancer cells. Radiation therapy may also help shrink tumor size and relieve symptoms caused by pressure on nearby tissue. It may be delivered alone or in combination with chemotherapy.
    Steroid medication may be given with chemotherapy or radiation therapy to make the therapy more effective. This medication may also decrease some of the side effects common with chemotherapy.

    Prevention

    There are no guidelines for preventing AIDS-related primary CNS lymphoma. Carefully managing HIV or AIDS may help keep the immune system strong and decrease the risk of certain cancers.

    RESOURCES

    Centers for Disease Control and Prevention http://www.cdc.gov

    National Cancer Institute http://www.cancer.gov

    CANADIAN RESOURCES

    AIDS Committee of Toronto www.actoronto.org

    Canadian AIDS Society http://www.cdnaids.ca

    References

    Central nervous system (CNS) lymphoma. Leukemia & Lymphoma Society website. Available at: http://www.lls.org/lymphoma/non-hodgkin-lymphoma/treatment/treatment-for-aggressive-nhl-subtypes/central-nervous-system-cns-lymphoma. Accessed February 9, 2016.

    General information about AIDS-related lymphoma. National Cancer Institute website. Available at: http://www.cancer.gov/types/lymphoma/patient/aids-related-treatment-pdq. Updated September 17, 2015. Accessed February 9, 2016.

    HIV infection. EBSCO DynaMed Plus website. Available at: http://www.dynamed.com/topics/dmp~AN~T114424/HIV-infection. Updated September 28, 2016. Accessed October 3, 2016.

    HIV-related lymphoma. Macmillan Cancer Support website. Available at: http://www.nhs.uk/ipgmedia/national/macmillan%20cancer%20support/assets/hiv-relatedlymphomamcs8pages.pdf. Updated January 1, 2013. Accessed February 9, 2016.

    Revision Information

    • Reviewer: EBSCO Medical Review Board David L. Horn, MD
    • Review Date: 03/2017
    • Update Date: 02/09/2016
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