Central nervous system involvement in non-Hodgkin's lymphoma: An analysis of 105 cases

MacKintosh, F. Roy; Colby, Thomas V.; Podolsky, W. J.; Burke, Jerome S.; Hoppe, Richard T.; Rosenfelt, Fred; Rosenberg, Saul A.; Kaplan, Henry S.

doi:10.1002/1097-0142(19820201)49:3<586::aid-cncr2820490331>3.0.co;2-c

Cited by 305 publications

(74 citation statements)

References 26 publications

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“…None of the patients had an LP before diagnosis with MCL, and none had CSF examinations as part of any routine or protocol-based staging work-up. The clinical indications for LP in our cohort were similar to those described for other patients suspected of having CNS lymphoma and included headache, mental status changes, and cranial nerve signs (14,20,21). CSF involvement by MCL was demonstrated in 40% (10/25) of the patients who underwent diagnostic LP for evaluation of CNS signs and/or symptoms, and CSF positivity was documented in 9% of the entire 108 MCL patient cohort.…”

Section: Discussionsupporting

confidence: 62%

Cerebrospinal Fluid Involvement in Mantle Cell Lymphoma

et al. 2002

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Mantle cell lymphoma (MCL) is an aggressive neoplasm that is incurable by standard therapy. Patients often present with high-stage disease (Stages III-IV) and frequently have involvement at multiple extranodal sites. Although the gastrointestinal tract, spleen, lung, pleura, bone marrow, and peripheral blood are among the most commonly involved tissues, MCL may also disseminate to so-called sanctuary sites including the central nervous system. Despite this, current clinical evaluations do not routinely include assessment of the cerebrospinal fluid (CSF) for lymphomatous infiltrates at presentation, and moreover, only few authors have specifically examined CSF involvement in MCL. In this study, we reviewed the medical records of 108 patients with MCL seen at three centers over a 5-year period to determine the rate of CSF sampling and the frequency of CSF involvement by MCL. The clinical and cytologic characteristics associated with CSF involvement were also studied. Central nervous system (CNS) signs and/or symptoms prompted CSF sampling in 25/108 patients (23%). Specific radiographic abnormalities were present in 9/25 patients (36%). CSF involvement by MCL was identified in 10 of the 25 CSF-sampled patients (40%) by morphology (3 patients), flow cytometry alone (1 patients), or both (6 patients). The CSF-positive cases included two blastoid variants. The CSF cytology of the nine morphologically positive cases was pleomorphic, and prominent cytoplasmic granules were observed in two cases. The overall rate of CSF involvement by MCL among the cohort was 9%, which is comparable to that reported in other selected studies examining this issue.

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Section: Discussionsupporting

confidence: 62%

Cerebrospinal Fluid Involvement in Mantle Cell Lymphoma

et al. 2002

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“…[3][4][5][6]18,19 If patients with DLBCL and treated with CHOP or CHOP-like regimens with or without CNS prophylaxis were considered, CNS events were in the range of 4% to 7%. 1,2,9, 10 The French Groupe d'Etude des Lymphomes de l'Adulte (GELA) demonstrated a reduction of CNS events to 2.2% in patients treated with ACVBP (doxorubicin, cyclophosphamide, vindesine, bleomycin, and prednisone) and both i.th.…”

Section: Discussionmentioning

confidence: 99%

CNS events in elderly patients with aggressive lymphoma treated with modern chemotherapy (CHOP-14) with or without rituximab: an analysis of patients treated in the RICOVER-60 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL)

Boehme

Schmitz

Zeynalova

et al. 2009

Blood

286

260

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“…However, no significant differences in the administration of rituximab-containing chemotherapies were seen between the two groups (P = 0.827). In all, six (7%) of 82 patients without CNS involvement at diagnosis received CNS prophylaxis (IT, n = 4; HDMTX 3 g ⁄ m 2 , n = 1; HDMTX 1 g ⁄ m 2 , n = 1), and 10 (37%) of 27 patients with CNS involvement at diagnosis received CNS treatment during the initial series of chemotherapies (IT, n = 4; RT, n = 1; IT+RT, n = 1; IT+HDMTX…”

Section: Methodsmentioning

confidence: 99%

Central nervous system involvement in intravascular large B‐cell lymphoma: A retrospective analysis of 109 patients

et al. 2010

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Intravascular large B-cell lymphoma (IVLBCL) is a rare disease entity with a high incidence of central nervous system (CNS) involvement at diagnosis. To evaluate CNS involvement, particularly recurrence including progression on therapy and relapse of IVLBCL, we retrospectively analyzed 109 patients with IVLBCL receiving chemotherapies with or without rituximab. In 82 patients (75%) without CNS involvement at initial diagnosis, risk of CNS recurrence at 3 years was 25% with a median follow-up in survivors of 39 months (range, 2-158 months). In 27 patients (25%) with CNS involvement at initial diagnosis, risk of CNS recurrence at 1 year was 25% with a median follow-up in survivors of 18 months (range, 10-77 months). Duration from diagnosis to CNS recurrence tended to be short in patients with CNS involvement at diagnosis. No significant difference in risk of CNS recurrence was found between patients receiving chemotherapies with or without rituximab. On multivariate analysis skin involvement at initial diagnosis was identified as a predictive factor for CNS recurrence in patients without CNS involvement at diagnosis (hazard ratio, 5.27; 95% confidence interval, 1.59-17.4; P = 0.007). Survival rate after CNS recurrence at 2 years was 12% in patients without CNS involvement at diagnosis. Central nervous system recurrence is a serious complication in IV-LBCL patients and optimal strategies for CNS involvement should be established to obtain further improvements to clinical outcomes in the rituximab era. (Cancer Sci 2010; 101: 1480-1486 C entral nervous system (CNS) involvement, particularly recurrence including progression during therapy or relapse after completion of chemotherapy, represents a serious and usually fatal complication of aggressive lymphoma.(1-5) Risk of CNS recurrence differs according to the histological type of lymphoma, occurring in 30-50% of cases involving Burkitt lymphoma (BL) and acute lymphoblastic leukemia ⁄ lymphoma (ALL ⁄ LBL), (6) and in around 5% of cases with aggressive nonHodgkin lymphoma (excluding BL and LBL) without CNS prophylaxis.(7) In BL and LBL, prophylaxis and early diagnosis of CNS involvement have led to major decreases in the risk of CNS relapse. (8,9) Adopting an initial treatment strategy including CNS prophylaxis is thus important, given the risk of CNS relapse.In previous reports, risk of CNS relapse in diffuse large B-cell lymphoma (DLBCL) has been approximately 5% and various CNS risk factors have been described, including advanced stage, increased international prognostic index (IPI), elevated serum lactate dehydrogenase (LDH), >1 extranodal site, and retroperitoneal disease. (3,4,10) Intravascular large B-cell lymphoma (IVLBCL) has recently been classified as a distinct rare disease entity according to the current World Health Organization (WHO) classification. (11) Intravascular large B-cell lymphoma is a rapidly progressive and disseminated, often fatal, aggressive lymphoma, characterized by selective growth of lymphoma cells only in the lumina of small vessels in ...

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Central nervous system involvement in non-Hodgkin's lymphoma: An analysis of 105 cases

Cited by 305 publications

References 26 publications

Cerebrospinal Fluid Involvement in Mantle Cell Lymphoma

Cerebrospinal Fluid Involvement in Mantle Cell Lymphoma

CNS events in elderly patients with aggressive lymphoma treated with modern chemotherapy (CHOP-14) with or without rituximab: an analysis of patients treated in the RICOVER-60 trial of the German High-Grade Non-Hodgkin Lymphoma Study Group (DSHNHL)

Central nervous system involvement in intravascular large B‐cell lymphoma: A retrospective analysis of 109 patients

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