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Fatal Lymphoma Strikes Impaired Immune Systems

By Amy Goldstein and Martin Weil
Washington Post Staff Writers
Tuesday, March 11, 1997; Page A09

Central nervous system lymphoma is a form of cancer that affects the brain and spinal cord, impairing a wide range of normal activities.

It does not tend to spread to other organs of the body, but it is considered fatal, even though some patients can live with it for a few years if they respond well to chemotherapy or radiation treatments. Other patients die within months or even weeks.

According to John Griffin, a professor of neurology at Johns Hopkins Hospital, CNS lymphoma has become more common since the 1970s for reasons that are only partly understood.

Part of the increase is linked to the AIDS epidemic. The disease is 1,000 times more common in people who are infected with the human immunodeficiency virus (HIV) than in the general population, Griffin said. But it also has become more common among people without AIDS. Those people include a very small number -- like Clarke -- whose immune systems are severely impaired for other reasons.

The first hints of the disease, which occurs not in the lymph glands but in lymphatic tissue of the central nervous system, often appear as subtle neurological problems, which may include difficulty concentrating and mild changes in behavior and interests.

The road to diagnosis usually begins with magnetic resonance imaging (MRI), in which the lymphoma may appear as white patches. Such abnormalities are typical, however, of several more-common diseases, including multiple sclerosis.

To confirm a diagnosis, a brain biopsy is required. But even then, the disease can be difficult to detect because the tissue sample must be taken from one of the exact parts of the brain where the lymphoma is located.

CNS lymphomas cannot be removed surgically because, unlike some brain cancer, it does not consist of a single tumor. Instead, some patients can be treated with chemotherapy, although such treatment is relatively ineffective in patients, such as Clarke, who have severely weakened immune systems. Such patients can be treated with radiation therapy, although the effectiveness of the treatment varies.

"Even if it completely disappears" for some time after treatment, there is "still a high recurrence rate," said Lawrence Kaplan, an oncologist at the University of California Medical Center in San Francisco. According to the National Cancer Institute, patients who do not receive treatment live an average of one to three months, regardless of whether they have AIDS.

The average overall survival for patients without AIDS is about 18 months, according to the NCI.

© Copyright 1997 The Washington Post Company

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