Several factors affect the prognosis and, therefore, the decisions about treatment. Factors associated with poorer prognosis include a history of AIDS before the diagnosis of lymphoma, T4 cells less than 200, a low performance status (the patient is weak and debilitated instead of vigorous and strong), involvement of the bone marrow (stage IV lymphoma) and the presence of primary central nervous system lymphoma, in which the only place the lymphoma is found is in the brain.
Having lymphoma in the body and also lymphoma cells in the spinal fluid is not a bad prognostic sign, provided that the spinal fluid is treated for involvement.
Very intensive regimens of multi-agent chemotherapy have traditionally been used for patients with lymphoma not associated with AIDS. But those with AIDS-related lymphoma may be treated more effectively and safely with low dosages of chemotherapy drugs. These are given along with additional chemotherapy into the spinal fluid to prevent relapse in this important site. If complete remission is achieved—in other words, all evidence of the disease disappears, with a return to a state of well-being—no further maintenance therapy or other treatment is given.
Chemotherapy Multiple chemotherapy drugs are given, usually once each month, for four to six
months.
• One commonly used regimen is a low-dose modification of M-BACOD, consisting of methotrexate ,
bleomycin , doxorubicin , cyclophosphamide , vincristine and dexamethasone .
