Thinking about CNS metastasis in cutaneous lymphoma: Analysis of existing data

Abstract

To determine some of the key clinical features that help prompt clinicians to pursue additional work-up for evaluation of CNS involvement of MF, we conducted a systematic review to better define characteristics, treatments, outcomes, and mortality in these patients. Our analyses indicated that neurologic surveillance after the diagnosis of MF is crucial. Review of systems should include change in mentation, vestibular, and ocular symptoms. Progression to CNS involvement does not always occur in tandem with cutaneous disease burden. Single-agent therapies can delay disease progression and improve prognosis. Multi-agent treatment does not improve survival.

Interferon alfa‐2a maintenance after salvage autologous stem cell transplantation in atypical mycosis fungoides with central nervous system involvement

“…Recently, Yang and Wickless reported a systemic review of 77 patients with MF with CNS metastasis, 10 of whom achieved complete remission . In their analysis, the median time between the diagnosis of MF and the detection of cerebral metastasis was 36 months.…”

“…13 Recently, Yang and Wickless reported a systemic review of 77 patients with MF with CNS metastasis, 10 of whom achieved complete remission. 29 In their analysis, the median time between the diagnosis of MF and the detection of cerebral metastasis was 36 months. None of those patients received autologous SCT, with the most common treatments being radiation, intrathecal methotrexate and single-agent chemotherapy, none of which was associated with a different clinical outcome.…”

“…29 As sensitive and specific detectors of cerebral metastasis, magnetic resonance imaging, computed tomography and cerebrospinal fluid analysis were tested, but none of these was found to be completely reliable. 29 Some researchers have suggested that elevated b2-microglobulin and lactate dehydrogenase (LDH) levels may be markers of CNS involvement. 13,27,30 However, while elevated serum LDH is a known marker of poor prognosis in MF, 31 it is still unclear whether LDH and serum b2-microglobulin could be useful as routine parameters in the diagnosis and follow-up of MF with respect to cerebral manifestations.…”

“…[35][36][37] Most treatment options only induce remissions of limited duration. [29][30][31] An additional challenge in the management of patients with advanced MF is their severely compromised immunity, with an aberrant T helper 2 phenotype and abnormal natural killer cell, cytotoxic T-cell and dendritic cell function. 9,38,39 SCT is a curative treatment option for advanced MF, with overall survival or relapse-free survival significantly longer in patients with allogeneic than with autologous SCT.…”

“…As sensitive and specific detectors of cerebral metastasis, magnetic resonance imaging, computed tomography and cerebrospinal fluid analysis were tested, but none of these was found to be completely reliable . Some researchers have suggested that elevated β2‐microglobulin and lactate dehydrogenase (LDH) levels may be markers of CNS involvement .…”