With a follow-up of 28 months, a study presented only in abstract form reported an impressive CR rate and

OS of 100% in patients treated with this regimen [74]. The studies performed in patients with BL are summarized in Table 4.7. We recommend that first-line treatment of BL in HIV-infected individuals includes regimens such as CODOX-M/IVAC and DA-EPOCH. No comparative studies have been performed and hence there is no optimal ‘gold-standard therapy’ (level of evidence 1B). We recommend that chemotherapy regimens should be combined with HAART therapy (level of evidence 1B). We recommend the addition of rituximab (level of evidence 1C). The incidence of CNS involvement has been suggested to be higher in ARL compared to the HIV-negative patients with NHL [23,75] and this may reflect Selleckchem EX 527 the more advanced stage at presentation or adverse features. Although there is no reported increase in incidence Tacrolimus of secondary CNS lymphoma in the HIV setting, there have been no specific studies that have addressed this in a randomized setting. However, the outcome of secondary

CNS involvement by lymphoma is very poor [76], and therefore the administration of preventative treatment during first-line therapy to reduce the incidence CNS relapse is a commonly adopted strategy for those patients with NHL perceived at risk. There is much debate regarding identification of these patients and the CYTH4 optimal strategy to adopt. Many studies [27,33,41,55–57,60,77–82] have reported the use of CNS prophylaxis and treatment in individuals with ARL, although there is a paucity of prospective or randomized trials and these studies have allowed individual institutions to administer CSF prophylaxis according to local protocol or preference. Presently a manuscript addressing these issues is in preparation by the British Committee for Standards in Haematology (BCSH) and thus this will not be discussed in detail. Immunochemotherapy

has significantly improved outcome in the HIV-negative setting, and a number of reports suggest that the overall risk of CNS relapse has decreased with the addition of rituximab to CHOP chemotherapy [83–85] although this has not been detected in all reports [86]. This observation supports the hypothesis that CNS relapse is less likely to occur if there is improved control of systemic disease. The identification of patients at risk of CNS relapse remains inconclusive [23]; however, data from immunocompetent individuals suggest that advanced stage, elevated serum LDH and extranodal disease [87] and involvement of specific anatomical sites such as: testes [88,89], paranasal sinuses [90], paraspinal disease, breast [91], renal [84], epidural space [92] and bone [93,94], predict a higher likelihood of CNS relapse. Both intrathecal and intravenous methotrexate have been used to prevent CNS disease.