Download PDF
Semin Neurol 2004; 24(4): 395-404
DOI: 10.1055/s-2004-861534
Copyright © 2004 by Thieme Medical Publishers, Inc., 333 Seventh Avenue, New York, NY 10001, USA.

Prevention and Treatment of Central Nervous System Involvement by Non-Hodgkin's Lymphoma: A Review of the Literature

Natalia Colocci1 , Michael Glantz3 , Lawrence Recht2
  • 1Department of Medical Oncology, Stanford University Medical Center, Palo Alto, California
  • 2Department of Neurology, Stanford University Medical Center, Palo Alto, California
  • 3Department of Neurology, University of Massachusetts Medical Center, Pittsfield, Massachusetts
Further Information

Publication History

Publication Date:
07 January 2005 (online)

    Permissions and Reprints

ABSTRACT

Direct invasion of the central nervous system (CNS) occurs in 5% of all patients with non-Hodgkin's lymphoma, either at the time of presentation, as a solitary site of relapse, or during the course of progressive disease. Over the last several years, several studies, mostly retrospective, have analyzed risk factors associated with this complication as well as various methods to both treat and prevent it. A systematic review of the literature reveals that although a profile of a patient at particularly high risk for developing disease can be identified, treatments are for the most part ineffective at improving survival in patients with CNS lymphoma, and there is no high-quality evidence that prophylaxis prevents its occurrence. A randomized controlled trial to assess the value of prophylaxis in this disease is warranted, and suggestions for how such a trial might be designed are included in this review.

KEYWORDS

Leptomeningeal lymphoma - CNS prophylaxis - intraventricular

REFERENCES

  • 1 Recht L, Mrugala M. Neurologic complications of hematologic neoplasms.  Neurol Clin. 2003;  21 87-105
    CrossrefPubMedGoogle Scholar
  • 2 Mrugala M, Recht L. Neurological complications of Hodgkin's disease. In: Batchelor T, ed. Lymphoma of the Nervous System. Boston; Butterworth-Heinemann 2004: 123-132
    Google Scholar
  • 3 Rappaport H. Tumors of the hematopoietic system. Atlas of Tumor Pathology, Series I, Section III, Fascicle 8. Washington, DC: Armed Forces Institute of Pathology;. 1966
    Google Scholar
  • 4 Tomita N, Kodama F, Kanamori H, Motomura S, Ishigatsubo Y. Prophylactic intrathecal methotrexate and hydrocortisone reduces central nervous system recurrence and improves survival in aggressive non-Hodgkin lymphoma.  Cancer. 2002;  95 576-580
    CrossrefPubMedGoogle Scholar
  • 5 Lennert K, Feller A C. Histopathology of Non-Hodgkin's Lymphoma (according to the up-dated Kiel classification). Berlin: Springer;. 1992
    Google Scholar
  • 6 Project N H. National Cancer Institute sponsored study of classifications of non-Hodgkin's lymphomas: summary and description of a working formulation for clinical usage.  Cancer. 1982;  49 2112-2135
    PubMedGoogle Scholar
  • 7 Harris N L, Jaffee E S, Stein H et al.. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group.  Blood. 1994;  84 1361-1392
    CrossrefPubMedGoogle Scholar
  • 8 Jaffee E S, Harris N L, Stein H et al.. World Health Organization Classification of Tumours of the Haematopoietic and Lymphoid Tissues. Lyon; IARC Press 2001
    Google Scholar
  • 9 Hiddemann W, Longo D L, Coiffier B et al.. Lymphoma classification-The gap between biology and clinical management is closing.  Blood. 1996;  88 4085-4089
    PubMedGoogle Scholar
  • 10 Hollender A, Kvaloy S, Nome O, Skovlund E, Lote K, Holte E. Central nervous system involvement following diagnosis of non-Hodgkin's lymphoma: a risk model.  Ann Oncol. 2002;  13 1099-1107
    CrossrefPubMedGoogle Scholar
  • 11 Bos G MJ, van Putten W L, van der Holt B et al.. For which patients with aggressive non-Hodgkin's lymphoma is prophylaxis for central nervous system disease mandatory?.  Ann Oncol. 1998;  9 191-194
    CrossrefPubMedGoogle Scholar
  • 12 Zinzani P L, Magagnoli M, Frezza G et al.. Isolated central nervous system relapse in aggressive non-Hodgkin's lymphoma: the Bologna experience.  Leuk Lymphoma. 1999;  32 571-576
    PubMedGoogle Scholar
  • 13 Haioun C, Besson C, Lepage E et al.. Incidence and risk factors of central nervous system relapse in histologically aggressive non-Hodgkin's lymphoma uniformly treated and receiving intrathecal central nervous system prophylaxis: a GELA study on 974 patients.  Ann Oncol. 2000;  11 685-690
    CrossrefPubMedGoogle Scholar
  • 14 Tomita N, Kodama F, Sakai R et al.. Predictive factors for central nervous system involvement in non-Hodgkin's lymphoma: significance of a very high serum LDH concentration.  Leuk Lymphoma. 2000;  38 335-343
    CrossrefPubMedGoogle Scholar
  • 15 Bollen E L, Brouwer R E, Hamers S et al.. Central nervous system relapse in non-Hodgkin's lymphoma.  Arch Neurol. 1997;  54 854-859
    PubMedGoogle Scholar
  • 16 van Biesen K, Ha C S, Murphy S et al.. Risk factors, treatment, and outcome of central nervous system recurrence in adults with intermediate-grade and immunoblastic lymphoma.  Blood. 1998;  91 1178-1184
    PubMedGoogle Scholar
  • 17 Ersbøll J, Schultz H B, Thomsen B LR, Keiding N, Nissen N I. Meningeal involvement by non-Hodgkin's lymphoma: symptoms, incidence, risk factors and treatment.  Scand J Haematol. 1985;  35 487-496
    PubMedGoogle Scholar
  • 18 Hoerni-Simon G, Suchaud J P, Eghbali H, Coindre J M, Hoerni B. Secondary involvement of the central nervous system in malignant non-Hodgkin's lymphoma.  Oncology. 1987;  44 98-101
    PubMedGoogle Scholar
  • 19 Liang R, Chiu E, Loke S L. Secondary central nervous system involvement by non-Hodgkin's lymphoma: the risk factors.  Hematol Oncol. 1990;  8 141-145
    PubMedGoogle Scholar
  • 20 Bashir R M, Bierman P J, Vose J M, Weisenburger D D, Armitage J O. Central nervous system involvement in patients with diffuse aggressive non-Hodgkin's lymphoma.  Am J Clin Oncol. 1991;  14 478-482
    CrossrefPubMedGoogle Scholar
  • 21 Keldsen N, Michalski W, Bentzen S, Hansen K, Thorling K. Risk factors for central nervous system involvement in non-Hodgkin's lymphoma.  Acta Oncol. 1996;  35 703-708
    PubMedGoogle Scholar
  • 22 Wolf M M, Cooper I A, Olver I N et al.. Non-Hodgkin's lymphoma involving the central nervous system.  Aust N Z J Med. 1985;  15 16-20
    CrossrefPubMedGoogle Scholar
  • 23 Recht L, Straus D J, Cirrincione C et al.. Central nervous system metastases from non-Hodgkin's lymphoma: treatment and prophylaxis.  Am J Med. 1988;  84 425-433
    CrossrefPubMedGoogle Scholar
  • 24 Bunn P A, Schein P S, Banks P M et al.. Central nervous system complications in patients with diffuse histiocytic and undifferentiated lymphoma: leukemia revisited.  Blood. 1976;  47 3-10
    PubMedGoogle Scholar
  • 25 Mackintosh F R, Colby T V, Podolsky W J et al.. Central nervous system involvement in non-Hodgkin's lymphoma: an analysis of 105 cases.  Cancer. 1982;  49 586-595
    PubMedGoogle Scholar
  • 26 Cairncross J G, Posner J B. Neurological complications of malignant lymphoma. In: Vinken PJ, Bruyn GW, eds. Handbook of Clinical Neurology. Amsterdam: North Holland Publishing;. 1980: 27-62
    Google Scholar
  • 27 Lokich J, Galbo C. Leptomeningeal lymphoma: perspectives on management.  Cancer Treat Rev. 1981;  8 103-110
    PubMedGoogle Scholar
  • 28 Griffin J W, Thompson R W, Mitchinson M J et al.. Lymphomatous leptomeningitis.  Am J Med. 1971;  51 200-208
    CrossrefPubMedGoogle Scholar
  • 29 Kaplan J G, DeSouza T G, Farkash A et al.. Leptomeningeal metastases: comparison of clinical features and laboratory data of solid tumors, lymphomas and leukemias.  J Neurooncol. 1990;  9 225-229
    CrossrefPubMedGoogle Scholar
  • 30 Glantz M J, Cole B F, Glantz L et al.. Cerebrospinal fluid cytology in patients with cancer: how to minimize false negative results.  Cancer. 1998;  82 733-739
    CrossrefPubMedGoogle Scholar
  • 31 Freilich R J, Krol G, DeAngelis L M. Neuroimaging and cerebrospinal fluid cytology in the diagnosis of leptomeningeal metastasis.  Ann Neurol. 1995;  38 51-57
    CrossrefPubMedGoogle Scholar
  • 32 Collie D A, Brush J P, Lammie G A et al.. Imaging features of leptomeningeal metastases.  Clin Radiol. 1999;  54 765-771
    CrossrefPubMedGoogle Scholar
  • 33 Glantz M J, Cole B F, Recht L et al.. High dose intravenous methotrexate for patients with leptomeningeal carcinomatosis: is intrathecal chemotherapy necessary?.  J Clin Oncol. 1998;  16 1561-1567
    PubMedGoogle Scholar
  • 34 Glantz M J, Hall W A, Cole B F et al.. Diagnosis, management, and survival of patients with leptomeningeal cancer based on cerebrospinal fluid-flow status.  Cancer. 1995;  75 2919-2931
    CrossrefPubMedGoogle Scholar
  • 35 Bokstein F, Lossos A, Lossos I S, Siegal T. Central nervous system relapse of systemic non-Hodgkin's lymphoma: results of treatment based on high-dose methotrexate combination chemotherapy.  Leuk Lymphoma. 2002;  43 587-593
    CrossrefPubMedGoogle Scholar
  • 36 Grossman S A, Finkelstein D M, Ruckdeschel J C et al.. Randomized prospective comparison of intraventricular methotrexate and thiotepa in patients with previously untreated neoplastic meningitis.  J Clin Oncol. 1993;  11 561-569
    PubMedGoogle Scholar
  • 37 Glantz M J, LaFollette S, Jaeckle K A et al.. Randomized trial of a slow-release versus a standard formulation of cytarabine for the intrathecal treatment of lymphomatous meningitis.  J Clin Oncol. 1999;  17 3110-3116
    PubMedGoogle Scholar
  • 38 Sullivan M P, Chen T, Dyment P G et al.. Equivalence of intrathecal chemotherapy and radiotherapy as central nervous system prophylaxis in children with acute lymphatic leukemia: a Pediatric Oncology Group study.  Blood. 1982;  60 948-958
    PubMedGoogle Scholar
  • 39 Chua S L, Seymor J F, Streater J, Wolf M M, Januszewicz E H, Prince H M. Intrathecal chemotherapy alone is inadequate central nervous system prophylaxis in patients with intermediate-grade non-Hodgkin's lymphoma.  Leuk Lymphoma. 2002;  43 1783-1788
    CrossrefPubMedGoogle Scholar
  • 40 Skarin A T, Canellos G P, Rosenthal D S et al.. Improved prognosis of diffuse histiocytic and undifferentiated lymphoma by use of high dose methotrexate alternating with standard agents (M-BACOD).  J Clin Oncol. 1983;  1 91-98
    PubMedGoogle Scholar
  • 41 Perez-Soler R, Smith T L, Cabinillas F. Central nervous system prophylaxis with combined intravenous and intrathecal methotrexate in diffuse lymphoma of aggressive histologic type.  Cancer. 1986;  57 971-977
    PubMedGoogle Scholar
  • 42 Johnson G J, Oken M M, Anderson J R et al.. Central nervous system relapse in unfavourable-histology non-Hodgkin's lymphoma: is prophylaxis indicated?.  Lancet. 1984;  2 685-687
    PubMedGoogle Scholar
  • 43 Freedman B. Equipoise and the ethics of clinical research.  N Engl J Med. 1987;  317 141-145
    CrossrefPubMedGoogle Scholar

Lawrence RechtM.D. 

Department of Neurology, Stanford University Medical Center

300 Pasteur Drive, Palo Alto, CA 94305

Ann Arbor, MI 48109-0311