Characteristics and outcomes of non-Hodgkin’s lymphoma patients with leptomeningeal metastases

Abstract

BackgroundLeptomeningeal metastasis is an uncommon but devastating complication. The incidence of non-Hodgkin’s lymphoma has been increasing in recent decades, due to the poor central nervous system penetration of drugs and the prolonged overall survival of patients, leptomeningeal metastases has gradually increased over time. Patients with leptomeningeal metastases have short survival durations and poor quality of life; there are few studies about non-Hodgkin’s lymphoma with leptomeningeal metastases. We investigated characteristics and outcomes of non-Hodgkin’s lymphoma patients with leptomeningeal metastases.MethodsThis study included 27 non-Hodgkin’s lymphoma patients with leptomeningeal metastases diagnosed at Tianjin Medical University Cancer Institute and Hospital between 2013 and 2016. Statistical analysis was performed to investigate the overall survival of non-Hodgkin’s lymphoma with leptomeningeal metastases.ResultsDiffuse large B cell lymphoma was the most common cancer subtype (21/27, 78%), and more than half of the patients showed extranodal involvement (18/27, 67%). Survival analysis has shown extranodal involvement (P = 0.0205), International Prognostic Index (P = 0.0112), performance status (P < 0.0001), parenchymal involvement (P = 0.0330) and received radiotherapy (P = 0.0056) were predictive factors of prognosis for these patients with leptomeningeal metastases. Cox regression analysis has shown patients with concurrent parenchymal involvement and received radiotherapy are correlated with good prognosis.ConclusionsGiven the small number of patients who were included, this study exhibited limitations with respect to analytical power and the random selection of patients. Nevertheless, this investigation revealed characteristics of non-Hodgkin’s lymphoma patients with leptomeningeal metastases and suggested that such patients could benefit from multimodal therapy.Electronic supplementary materialThe online version of this article (10.1007/s10147-018-1268-5) contains supplementary material, which is available to authorized users.

Intrathecal Rituximab for Treatment of Leptomeningeal NonHodgkin’s Lymphoma: A Case Report

“…The incidence of leptomeningeal NHL is rising due to prolonged survival of patients and poor penetration of chemotherapeutic agents into the CNS [2]. Prognosis is grim and optimal treatment is yet to be established as per our literature review.…”

“…Leptomeningeal metastasis (LM) is more common as compared to parenchymal involvement in CNS NHL. Due to different histopathological types of lymphoma, the incidence of LM varies from 2.8 to 24.4% [1,2]. LM typically has a poor prognosis and no optimal treatment has been established.…”

Freiburg Neuropathology Case Conference

“…Leptomeningeal involvement in peripheral Non-Hodgkin’s lymphomas (NHLs) occurs in 6–8% of patients [ 24 , 25 ]. The frequency of leptomeningeal infiltrates increases with the clinical aggressiveness of the tumor [ 26 ]. On the other hand, primary lymphomas of the dura are prevalently low-grade B cell lymphomas.…”

“…Since MALT lymphoma cells can replace the germinal centers, the tumor can mimic follicular lymphomas. However, the absence of a pronounced extrafollicular B cell fraction and the expression of follicular-center markers (especially CD10) supports the diagnosis of follicular lymphoma [ 26 , 27 ]. Due to the small number of FL of the dura reported in the literature, prognostic evidence is limited.…”