The median survival for the whole group was only 41.7 weeks, but for patients 60 years of age or younger, the median survival was 47.4 months. A review of the literature suggests that patients older than 60 years of age have very poor results. Currently, most regimens are employing high-dose methotrexate and require hospitalization. Retrospective data suggest a decreased risk of dementia when chemotherapy is employed prior to radiation therapy. The use of systemic chemotherapy alone, with or without osmotic blood-brain barrier disruption, may avoid the cognitive loss observed with radiation therapy.
Glucocorticoids can also produce substantial but short-lived remissions.
Steroid efficacy may complicate the diagnostic evaluation by obscuring the histologic findings. Treatment of these patients requires special consideration and is further outlined in the summary on AIDS-related lymphoma. Nelson DF, Martz KL, Bonner H, et al. Gabbai AA, Hochberg FH, Linggood RM, et al. Blay JY, Bouhour D, Carrie C, et al.