AIDS-Related Primary Central Nervous System Lymphoma
AIDS-Related Primary CNS Lymphoma
Lymphomas are cancers of the lymph system. The lymph system is a series of nodes, channels, and tissue throughout the body. There are different types of lymphomas. The lymphomas terms discussed here include:
- Primary central nervous system (CNS) lymphomas—occurs in the brain and/or spinal cord.
- AIDS-related primary CNS lymphoma—occurs in people with HIV. It is one of the complications that show that AIDS has developed.
AIDS-related primary CNS lymphoma is a type of non-Hodgkin lymphoma (NHL). NHL can be more aggressive in people with AIDS.
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Lymphoma starts because of DNA damage in a new white blood cell. The damaged cell divides and grows in an abnormal way. This in turn creates more damaged cells. The cells can form a tumor and invade nearby tissue. The cancer can also spread to other areas of your body. It is not clear what causes the change to DNA. It may be a combination of genetics and factors in your environment.
Having HIV infection increases the risk of AIDS-related primary CNS lymphoma.
HIV damages the white blood cells in the body. The body will need to make more white blood cells to replace the damaged cells. This increases the chance that a white blood cell with damaged DNA can develop.
HIV also lowers the immune system. This makes people more vulnerable to cancer in general.
Cancer growth can put pressure on tissue around it. It can cause swelling that also puts pressure on brain tissue. Brain tissue, nerves, and the spinal cord can all be affected. This will cause a wide range of symptoms. Some examples include:
- Nausea and vomiting
- Limb weakness or pain
- Hearing or vision problems
- Back pain
- Difficulty swallowing
- Difficulty controlling the flow of urine
- Changes in alertness
You will be asked about your symptoms and past health. A physical exam will be done. A basic check of your nervous system or an eye exam may be done if you have certain symptoms.
The doctor may test fluids to look for signs of lymphoma. This can be done with:
- Blood tests
- Lumbar puncture—to tests fluids around the spinal cord and brain
A biopsy may be done if a tumor is found. A small sample of the growth will be removed. It will then be closely examined to make a diagnosis.
Images of the spine and brain may also be taken. They can help to find tumors and see what tissue is affected. Images can be taken with:
Tests will help to determine the stage of the cancer. Staging is based on how far the cancer has spread and what body parts are affected. This will help to make a treatment plan
Treatment depends on the type and stage of the cancer. Your care plan will also depend on how aggressive your cancer is. Treatment for HIV infection will start or continue as well.
Cancer treatments can weaken the immune system even more. It is important to manage the HIV infection and keep the immune system as strong as possible. Treatment for HIV includes highly active antiretroviral therapy (HAART). These medicines can improve the immune system. Chemotherapy medicine can interfere with some AIDS medicine. Your care team may need to adjust medicine during treatment.
Treatment for the lymphoma may include:
Chemotherapy and Radiation Therapy
Chemotherapy (Chemo) can affect cells all over the body. This makes it a common choice of treatment for lymphoma. Chemo uses drugs to kill cancer cells. It may be passed into the blood stream or straight into the fluid around the brain (intrathecal). While chemo is focused on killing cancer cells, some healthy cells are affected as well. This can cause a range of side effects. It is often given over a number of cycles. Each cycle may include a few weeks of rest after a few days of treatment.
Radiation therapy is the delivery of high energy to a set area. This energy disrupts the DNA in the cancer cells. It will stop theses cells from growing and making more cancer cells. Radiation therapy may also help shrink tumor size. This may help to relieve symptoms caused by larger growths. It may be given alone or in combination with chemo.
Steroid medicine may also be given with either therapy. It may make the therapy more effective. This medicine may also decrease some of the side effects of chemo.
There are no specific steps to prevent this type of cancer. Follow your HIV or AIDS care plan. It may help to keep the immune system strong and decrease the risk of certain cancers.
Centers for Disease Control and Prevention
National Cancer Institute
ACT—AIDS Committee of Toronto
Canadian AIDS Society
AIDS-related lymphoma treatment (PDQ)—patient version. National Cancer Institute website. Available at: https://www.cancer.gov/types/lymphoma/patient/aids-related-treatment-pdq. Updated October 12, 2016. Accessed March 29, 2018.
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 March 29, 2018.
HIV-related lymphoma. Macmillan Cancer Support website. Available at: https://www.macmillan.org.uk/information-and-support/lymphoma/lymphoma-non-hodgkin/types-of-non-hodgkin-lymphoma/hiv-related-lymphoma.html. Accessed March 29, 2018.
Overview of HIV infection. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T114424/Overview-of-HIV-infection. Updated March 5, 2018. Accessed March 29, 2018.
Last reviewed March 2018 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP Last Updated: 12/13/2018