Isolated Central Nervous System Relapse in Aggressive Non-Hodgkin's Lymphoma: the Bologna Experience

Abstract

Isolated central nervous system (CNS) relapse was evaluated in terms of incidence, risk factors, and outcome in a consecutive cohort of 175 patients with aggressive non-Hodgkin's lymphoma in which no case of lymphoblastic or Burkitt's lymphoma was encountered. All these patients had obtained a complete remission with first-line treatment and none had received prophylactic CNS treatment at diagnosis. Nine patients (5.2%) developed isolated CNS relapse after a median of 8 months from diagnosis. CNS involvement was documented by cerebrospinal fluid (CSF) cytology in 4 patients and on the basis of radiologic and clinical features in 5 others. Factors significantly associated with a greater likelihood of CNS relapse were advanced stage, B symptoms, bone marrow involvement, and high LDH levels in univariate analysis with only advanced stage being of significance in multivariate analysis. All relapsed CNS lymphoma patients died within a median time of 4 months from the disease recurrence, confirming the poor prognosis after CNS relapse and stressing the need to develop new treatment strategies for patients at high risk of CNS recurrence.

Brain parenchyma involvement as isolated central nervous system relapse of systemic non-Hodgkin lymphoma: an International Primary CNS Lymphoma Collaborative Group report

“…1,[17][18][19][20] Although retrospective, our international collaboration allowed us to assemble the largest series to date of patients with CNS relapse in the brain parenchyma as initial relapse site. Our eligibility criteria were very select.…”

“…These strict criteria may partially explain the longer median time from systemic non-Hodgkin lymphoma diagnosis to brain relapse and the longer overall survival in our series, compared with other series. 1,[17][18][19][20] Participating IPCG investigators searched their databases and registries for eligible patients between the years 1980 and 2004 and submitted available information. The dataset is not comprehensive, contains missing values, may not be representative, and cannot determine the incidence of this complication.…”

Discordant bone marrow involvement in non-Hodgkin lymphoma

“…1,2,4,5,[19][20][21][22]25 The role of upfront autologous stem cell transplant following first remission in transformed lymphomas has not been well established and there is no data assessing its role in discordant cases. 51,52 An increased risk of central nervous system (CNS) involvement and CNS relapse in newly diagnosed patients with DLBCL who have concordant BMI has been well described, [53][54][55] and therefore cerebrospinal fluid sampling for lymphomatous involvement and prophylactic CNS-directed therapy are common practice. 56,57 In contrast, discordant indolent BMI in patients with nodal DLBCL has not been associated with an increased risk of CNS involvement/relapse and should not mandate cerebrospinal fluid sampling in the absence of other high-risk characteristics.…”

Phase 2 study of intrathecal, long‐acting liposomal cytarabine in the prophylaxis of lymphomatous meningitis in human immunodeficiency virus‐related non‐Hodgkin lymphoma

“…[1][2][3][4][5][6][7][8][9][10][11] Moreover, the overall incidence of CNS recurrence with or without intrathecal prophylaxis is around 5%. 3,[12][13][14][15] Since the beginning of the acquired immune deficiency syndrome (AIDS) epidemic, a close association between human immunodeficiency virus (HIV) infection and high-grade NHL has been reported. At onset, HIV-NHLs fall within stages III and IV in >70% to 98% of cases with extranodal involvement, mainly the gastrointestinal tract, the bone marrow, and the CNS.…”