Non‐hodgkin's Lymphoma Involving the Central Nervous System

Abstract

In 44 out of 758 patients (5.8%) with non-Hodgkin's lymphoma presenting between 1971 and 1982, the central nervous system (CNS) was involved. Patients with a diffuse histology had a 7.6% (34/449) incidence of CNS involvement compared to 3.9% (10/257) for patients with nodular lymphoma. In 63% of patients there was evidence of progressive systemic lymphoma at the time of diagnosis of CNS disease and in 23% CNS relapse occurred in clinical remission. Bone marrow was involved in 34% of patients at diagnosis and in 52% at some time prior to the onset of CNS complications. Cerebrospinal fluid cytology was positive in 63% and an elevated protein level was found in 95% of patients. The median length of survival of the 44 patients was only 3.2 months, but patients who responded to treatment of CNS lymphoma survived significantly longer than those who showed no response or progressed on therapy. Complete response to CNS treatment was achieved in five patients, of whom none relapsed in the CNS and two are long-term disease-free survivors. CNS prophylaxis appears justified for patients with lymphoblastic lymphoma, Burkitt's tumour, and diffuse undifferentiated lymphoma, who are at high risk of developing CNS complications. Patients with diffuse histiocytic, and diffuse poorly differentiated lymphocytic, lymphoma who have bone marrow involvement may also benefit from CNS prophylaxis.

Clinical, immunologic, and pathologic correlates of bone marrow involvement in 291 patients with acquired immunodeficiency syndrome–related lymphoma

“…7 In HIV-negative patients with high-grade NHL, bone marrow involvement correlates with lymphomatous involvement of the central nervous system. [34][35][36][37] The current report clearly establishes a Figure 1. Survival in AIDS-NHL patients with and without bone marrow involvement.…”

“…Bone marrow involvement has been a criterion for receipt of CNS prophylactic therapy in patients with HIV-negative lymphoma. 35,37,38 On the basis of the current report, we would suggest a similar strategy in HIV-positive patients with marrow or bone involvement. Use of intrathecal cytosine arabinoside has been shown to be efficacious in this regard in patients with ARL.…”

Central nervous system‐directed preventative therapy in adults with lymphoma

“…There is universal agreement that BL (e.g. Wolf et al , 1985) and LBL (e.g. MacKintosh et al , 1982) require CNS‐directed therapy to prevent CNS relapse.…”

Lymphoma at uncommon sites

“…Wolf et al 129 reviewed 758 patients with NHL and identified 44 (5·9 per cent) with CNS disease, with over 50 per cent of these cases having bone marrow involvement, a finding supported by other reviews. CNS relapse is also relatively common, particularly in high grade disease.…”