acyclovir and Central-Nervous-System-Neoplasms

Glioblastoma multiforme (GBM) is the most common primary malignant tumor of the central nervous system (CNS) and one of the most lethal cancers in adults and children. Despite aggressive treatment with surgery, radiation, and chemotherapy, median survival is less than 15 months and overall survival is less than 10 % at 5 years. Development of therapeutics for malignant gliomas has been hampered by their natural complexity as well as protective mechanisms unique to the CNS. Better understanding of the pathogenesis of GBM is opening the path to novel, specific-targeted therapies. Recently, multiple immunotherapy approaches have been acquiring substantial indication of therapeutic efficacy with a very safe profile. Examples of the leading clinical approaches for GBM will be discussed in detail in this review.

Topics: Acyclovir; Autoantigens; Central Nervous System Neoplasms; Combined Modality Therapy; Dacarbazine; Dendritic Cells; Glioblastoma; Humans; Immunotherapy; Immunotherapy, Active; Signal Transduction; Temozolomide; Valacyclovir; Valine

Most of the human herpesviruses have a unique relationship with the central nervous system. In this review we summarize recent developments in the establishment of viral latency, and discuss the nervous system illnesses instigated by direct viral cytopathic effect, by immune activation, and by neoplastic events. Special consideration is given to herpesvirus infections in the context of acquired immunodeficiency syndrome, and in association with neonatal infections. New diagnostic techniques and treatments are also summarized.

Topics: Acyclovir; AIDS-Related Opportunistic Infections; Central Nervous System Diseases; Central Nervous System Neoplasms; Herpesviridae; Herpesviridae Infections; Herpesvirus 4, Human; Humans; Polymerase Chain Reaction; Tumor Virus Infections

Topics: Acyclovir; Adolescent; Antiviral Agents; Bell Palsy; Central Nervous System Neoplasms; Facial Nerve; Humans; Magnetic Resonance Imaging; Male; Optic Nerve Diseases; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Prednisone; Recovery of Function; Recurrence; Spinal Puncture; Treatment Outcome; Valacyclovir; Valine

Visceral disseminated varicella-zoster virus (VZV) infection occurred with acute graft-versus-host disease in a 33-year-old Japanese male with non-Hodgkin lymphoma who had undergone allogeneic stem cell transplantation from an HLA-identical sibling after reduced intensity conditioning chemotherapy. Although ganciclovir and acyclovir treatment was effective temporarily, the number of VZV-DNA copies in the blood remained at a high level, and the hepatitis was prolonged. The patient was treated with foscarnet, which led to improvement of the VZV viremia and the hepatic dysfunction. Foscarnet therapy should be considered for acyclovir-resistant VZV infection in the setting of allogeneic hematopoietic stem cell transplantation.

Topics: Acyclovir; Adult; Antiviral Agents; Central Nervous System Neoplasms; Drug Resistance, Viral; Foscarnet; Graft vs Host Disease; Hematopoietic Stem Cell Transplantation; Herpes Zoster; Humans; Lymphoma, Non-Hodgkin; Male; Recurrence; Transplantation, Homologous

Detection of Epstein-Barr virus (EBV) DNA in the cerebrospinal fluid (CSF) is associated with acquired immunodeficiency syndrome (AIDS)-related brain lymphoma. Real-time polymerase chain reaction (PCR) was performed to quantify EBV DNA in CSF and plasma from 42 patients with AIDS-related non-Hodgkin's lymphoma (NHL). Twenty patients had primary central nervous system lymphoma (PCNSL) and 22 systemic NHL, including 12 with central nervous system involvement (CNS-NHL). As controls, 16 HIV-infected patients with other CNS disorders were examined. EBV DNA was detected in the CSF from 16/20 (80%) patients with PCNSL, 7/22 (32%) with systemic NHL, 8/12 (67%) with CNS-NHL, and 2/16 (13%) of the controls. The viral EBV DNA levels were significantly higher in the CSF from patients with PCNSL or CNS-NHL compared to patients with systemic NHL or controls. EBV DNA was detected in plasma from 5/16 (31%) patients with PCNSL, 9/16 (56%) with systemic NHL, 4/9 (44%) with CNS-NHL, and 4/15 (27%) controls. No difference in plasma viral load was found between patient groups. From the patients with CNS-NHL, plasma samples drawn prior to CNS involvement contained significantly higher EBV DNA levels than those from systemic NHL patients without subsequent CNS involvement. EBV DNA levels in the CSF, but not in plasma, from patients treated with antiherpes drugs were significantly lower than in untreated patients. High CSF EBV DNA levels were found in HIV-associated brain lymphomas and the viral load can be clinically useful. High plasma EBV DNA levels might predict CNS involvement in systemic NHL.

Topics: Acyclovir; Antiviral Agents; Biomarkers, Tumor; Burkitt Lymphoma; Central Nervous System Neoplasms; DNA, Viral; Epstein-Barr Virus Infections; Ganciclovir; Herpesvirus 4, Human; Humans; Lymphoma, AIDS-Related; Lymphoma, Large B-Cell, Diffuse; Polymerase Chain Reaction; Retrospective Studies; Viral Load

Epstein-Barr virus-associated lymphoproliferative disease (EBV-LPD) is a serious disorder seen in various states of immunodeficiency, often with a fatal outcome. In this article, a patient with EBV-lymphoma after autologous stem cell rescue for treatment of a nonhematologic solid tumor is described. The child, a 4-year-old boy, had unilateral retinoblastoma with metastatic spread to the central nervous system. He had previously received both local tumor bed and craniospinal radiation therapy together with intensive myeloablative alkylator chemotherapy before autologous stem cell rescue. Histologically confirmed lymphoma with evidence of active EBV proliferation developed within cervical lymph nodes 3 weeks after his first autologous stem cell rescue. A complete clinical remission of the lymphadenopathy was obtained after infusions of rituximab (an anti-CD20 monoclonal antibody), acyclovir, and high-titer anticytomegalovirus immunoglobulin. The patient died approximately 6 months later of persistent and progressive retinoblastoma without any clinical evidence of lymphoma. It is concluded that EBV-LPD should be included in the differential diagnosis in patients in whom lymphadenopathy develops after autologous stem cell rescue.

Topics: Acyclovir; Antibodies, Monoclonal; Antibodies, Monoclonal, Murine-Derived; Antineoplastic Agents, Phytogenic; Antineoplastic Combined Chemotherapy Protocols; Antiviral Agents; Carboplatin; Central Nervous System Neoplasms; Child, Preschool; Combined Modality Therapy; Cyclophosphamide; Disease Progression; Epstein-Barr Virus Infections; Etoposide; Eye Enucleation; Eye Neoplasms; Fatal Outcome; Hematopoietic Stem Cell Transplantation; Herpesvirus 4, Human; Humans; Immunocompromised Host; Immunoglobulins, Intravenous; Immunosuppressive Agents; Immunotherapy; Lymphoma, Large B-Cell, Diffuse; Male; Meningeal Neoplasms; Methylprednisolone; Neoplasm Recurrence, Local; Neoplasms, Second Primary; Optic Nerve Neoplasms; Radiotherapy, Adjuvant; Retinoblastoma; Rituximab; Thiotepa; Vincristine