Central nervous system metastases from non-hodgkin's lymphoma: Treatment and prophylaxis

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Abstract

Central nervous system (CNS) lymphoma was identified in 96 patients treated for non-Hodgkin's lymphoma at Memorial Sloan-Kettering Cancer Center between 1975 and 1981. During the same period, 68 other patients with non-Hodgkin's lymphoma but no CNS disease received prophylactic CNS chemotherapy. In the 156 total patients, the lymphomas were diffuse in 96 percent, and 67 percent were stage IV at diagnosis. CNS involvement was present at initial diagnosis in 27 percent, at relapse in 26 percent, and during the course of progressive systemic disease in 47 percent. CNS involvement was asymptomatic in 10 percent. Cytologic study of the cerebrospinal fluid was the most sensitive and specific laboratory test, but often (22 percent) more than one lumbar puncture was required to identify malignant cells. CNS lymphoma was treated in 85 patients, 46 by intracerebroventricular cannulae; 81 percent improved. Although median survival after the diagnosis of CNS disease was four months, there were seven longterm disease-free survivors and the CNS disease contributed to death in only 14 percent. In 52 percent of treated patients, there was no CNS lymphoma at autopsy. CNS prophylaxis was with methotrexate or cytosine arabinoside, usually by lumbar puncture; an intraventricular cannula was used in seven patients. Although this group of high-risk patients with non-Hodgkin's lymphoma had a high systemic response rate and the median projected survival was greater than five years, CNS lymphoma developed in eight patients (12 percent). In five, CNS lymphoma occurred as an apparently isolated relapse site. The role of CNS chemoprophylaxis in high-risk patients with non-Hodgkin's lymphoma is still uncertain.

References (48)

  • L Levitt et al.

    CNS involvement in the non-Hodgkin's lymphomas

    Cancer

    (1980)
  • J Lokick et al.

    Leptomeningeal lymphoma: perspectives on management

    Cancer Treat Rev

    (1981)
  • F Macintosh et al.

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

    Cancer

    (1982)
  • G Venables et al.

    Intracranial disease in non-Hodgkin's lymphoma

    Q J Med

    (1980)
  • PP Carbone et al.

    Report of the committee on Hodgkin's disease staging

    Cancer

    (1971)
  • H Rappaport

    Tumors of the hematopoietic system

    (1966)
  • B Koziner et al.

    Treatment of advanced diffuse histiocytic lymphoma

  • D Slater et al.

    Lymphoblastic lymphoma in adults

    J Clin Oncol

    (1986)
  • EL Kaplan et al.

    Non-parametric estimation from incomplete observations

    J Am Stat Assoc

    (1958)
  • R Peto et al.

    Conservatism of the approximation (O-E)2/E in the log-rank test for survival data or tumor incidence data

    Biometrics

    (1973)
  • S Monfardini et al.

    Central nervous system involvement in non-Hodgkin's lymphoma: value of lumbar puncture as initial staging procedure

    Tumori

    (1981)
  • JP Glass et al.

    Malignant cells in cerebrospinal fluid (CSF)

  • P Gutin et al.

    Treatment of malignant disease with intrathecal Thiotepa: a phase II study

    Cancer Treat Rep

    (1977)
  • P Gutin et al.

    Intrathecal N, Ni, Nii triethylene-thiophosphoramide (Thio-tepa NSC 6396) in the treatment of malignant meningeal disease

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    Current address: Department of Neurology, University of Massachusetts Medical School, Worcester, Massachusetts 01605.

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