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Central Nervous System Relapse in Non-Hodgkin LymphomaA Single-Center Study of 532 Patients
E. L. E. M. Bollen, MD, PhD;
R. E. Brouwer, MD;
S. Hamers, MD;
J. Hermans, PhD;
Ph. M. Kluin, MD, PhD;
S. U. C. Sankatsing;
R. V. A-Tjak;
M. Veselic Charvat, MD;
J. C. Kluin-Nelemans, MD, PhD
Arch Neurol. 1997;54(7):854-859.
Abstract
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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.
Author Affiliations
From the Departments of Neurology (Drs Bollen and Hamers and Messrs Sankatsing and A-Tjak) and Hematology (Drs Brouwer and Kluin-Nelemans) and Laboratory of Pathology (Drs Kluin and Charvat), Leiden University Hospital, and the Department of Medical Statistics, Leiden University (Dr Hermans), Leiden, the Netherlands.
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