Central nervous system relapse in non-Hodgkin lymphoma. A single-center study of 532 patients

E. L. Bollen, R. E. Brouwer, S. Hamers, J. Hermans, M. Kluin, S. U. Sankatsing, R. V. A-Tjak, M. V. Charvat and J. C. Kluin-Nelemans
Department of Neurology, Leiden University Hospital, The Netherlands.

OBJECTIVES: To define the cumulative risk of central nervous system (CNS) relapse in systemic non-Hodgkin lymphoma (NHL); to assess the risk factors of age, sex, malignancy grade, stage, localization, and response to initial therapy; and to evaluate the effect of CNS prophylaxis. PATIENTS AND METHODS: An unselected group of 532 patients with systemic NHL. A retrospective analysis. RESULTS: Eleven patients presented with systemic as well as CNS localization, whereas in 55 patients, CNS relapse occurred later. The cumulative risk of CNS relapse at 4 years for all 532 patients was 19%. High-grade NHL carried a 39% risk of CNS relapse, with the vast majority of relapses occurring in the first 14 months after the initial diagnosis. The cumulative risk in patients with intermediate-grade NHL was considerable (22%) and dispersed throughout a much longer period (6 years). Patients with low-grade NHL still carried a 7% risk of CNS relapse; in all these patients, low malignancy grade was transformed into a higher malignancy grade at that time. In a multivariate analysis, high- and intermediate-grade NHL and advanced stage were independent risk factors for CNS relapse. There was not any strong evidence for a beneficial role of CNS prophylaxis in patients with intermediate- and high-grade NHL, but a retrospective analysis cannot be conclusive with regard to the effect of therapy. Systemic relapse occurred rapidly after CNS relapse, resulting in a median survival time after CNS relapse of only 2 months. CONCLUSIONS: Patients with high- and intermediate-grade NHL carry a considerable risk of CNS relapse. Advanced stage is an additional independent risk factor. The role of CNS prophylaxis seems to be disappointing, but a retrospective analysis cannot be conclusive. Prognosis after CNS relapse is poor.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Brain parenchyma involvement as isolated central nervous system relapse of systemic non-Hodgkin lymphoma: an International Primary CNS Lymphoma Collaborative Group report
Doolittle et al.
Blood 2008;111:1085-1093.
ABSTRACT | FULL TEXT  

Central nervous system involvement in mantle cell lymphoma
Ferrer et al.
Ann Oncol 2008;19:135-141.
ABSTRACT | FULL TEXT  

Case 11-2007 -- A 59-Year-Old Man with Neck Pain, Weakness in the Arms, and Cranial-Nerve Palsies
Greer et al.
NEJM 2007;356:1561-1570.
FULL TEXT  

Incidence and risk factors of central nervous system recurrence in aggressive lymphoma--a survey of 1693 patients treated in protocols of the German High-Grade Non-Hodgkin's Lymphoma Study Group (DSHNHL)
Boehme et al.
Ann Oncol 2007;18:149-157.
ABSTRACT | FULL TEXT  

Central nervous system involvement in indolent lymphomas
Spectre et al.
Ann Oncol 2005;16:450-454.
ABSTRACT | FULL TEXT  

Central nervous system involvement following diagnosis of non-Hodgkin's lymphoma: a risk model
Hollender et al.
Ann Oncol 2002;13:1099-1107.
ABSTRACT | FULL TEXT  

Central Nervous System Lymphoma
Lister et al.
ASH Education Book 2002;2002:283-296.
ABSTRACT | FULL TEXT  

Importance of dose intensity in neurooncology clinical trials: Summary Report of the Sixth Annual Meeting of the Blood-Brain Barrier Disruption Consortium
Doolittle et al.
Neuro Oncol 2001;3:46-54.
ABSTRACT  

CNS Involvement in Primary Mediastinal Large B-Cell Lymphoma
Bishop et al.
JCO 1999;17:2479-2479.
ABSTRACT | FULL TEXT