title: Predictive factors for central nervous system involvement in non-Hodgkin's lymphoma: significance of very high serum LDH concentrations.
abstract: Factors predictive for central nervous system (CNS) involvement at presentation were investigated in 152 patients with non-Hodgkin's lymphoma (NHL) except for lymphoblastic cell lymphoma and small noncleaved cell lymphoma. Twelve patients developed CNS involvement during their disease course. The incidence was 7.9% of all the patients studied and 17.0% of the patients with serum LDH concentration > or = two times the upper limit of normal (2N). By univariate analysis, stage IV disease (P = .023), a serum LDH concentration > or = 2 N (P = .009), and bone marrow involvement (P = .016) were risk factors for CNS involvement. Multivariate logistic regression analysis identified a serum LDH concentration > or = 2 N (P = .032) as an independent predictor for CNS involvement. All 12 patients who developed CNS involvement were among the 126 patients with diffuse lymphoma, whereas none of the 17 patients with follicular lymphoma developed CNS involvement, although the difference was not statistically significant. The median survival of the patients with CNS involvement was only 4.5 months. We conclude that a serum LDH concentration > or = 2N at presentation is a significant predictive factor for CNS involvement for NHL patients without lymphoblastic lymphoma and small noncleaved cell lymphoma. Therefore, we would suggest that CNS prophylaxis should be considered for patients with a serum LDH concentration > or = 2N at presentation and diffuse lymphoma once a complete remission is achieved.
authors.affiliation: Department of Hematology and Chemotherapy, Kanagawa Cancer Center, Yokohama, Japan.
authors.forename: N
authors.initials: N
authors.lastname: Tomita
authors.forename: F
authors.initials: F
authors.lastname: Kodama
authors.forename: R
authors.initials: R
authors.lastname: Sakai
authors.forename: H
authors.initials: H
authors.lastname: Koharasawa
authors.forename: M
authors.initials: M
authors.lastname: Hattori
authors.forename: J
authors.initials: J
authors.lastname: Taguchi
authors.forename: H
authors.initials: H
authors.lastname: Fujita
authors.forename: J
authors.initials: J
authors.lastname: Tanabe
authors.forename: S
authors.initials: S
authors.lastname: Fujisawa
authors.forename: H
authors.initials: H
authors.lastname: Fukawa
authors.forename: H
authors.initials: H
authors.lastname: Harano
authors.forename: H
authors.initials: H
authors.lastname: Kanamori
authors.forename: H
authors.initials: H
authors.lastname: Miyashita
authors.forename: M
authors.initials: M
authors.lastname: Matsuzaki
authors.forename: K
authors.initials: K
authors.lastname: Ogawa
authors.forename: S
authors.initials: S
authors.lastname: Motomura
authors.forename: A
authors.initials: A
authors.lastname: Maruta
authors.forename: Y
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D014408:Biomarkers, Tumor / Q000097:blood*; D001761:Bleomycin / Q000008:administration & dosage; D002490:Central Nervous System / Q000473:pathology*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003520:Cyclophosphamide / Q000008:administration & dosage; D003561:Cytarabine / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D015994:Incidence; D007770:L-Lactate Dehydrogenase / Q000097:blood*; D002955:Leucovorin / Q000008:administration & dosage; D015993:Life Tables; D008228:Lymphoma, Non-Hodgkin / Q000145:classification / Q000188:drug therapy / Q000201:enzymology / Q000401:mortality / Q000473:pathology* / Q000532:radiotherapy; D008578:Meninges / Q000473:pathology*; D008727:Methotrexate / Q000008:administration & dosage; D009363:Neoplasm Proteins / Q000097:blood*; D009460:Neurologic Examination; D011237:Predictive Value of Tests; D011239:Prednisolone / Q000008:administration & dosage; D011241:Prednisone / Q000008:administration & dosage; D016019:Survival Analysis; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D014408:Biomarkers, Tumor; D009363:Neoplasm Proteins; D003561:Cytarabine; D001761:Bleomycin; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone; D007770:L-Lactate Dehydrogenase; D002955:Leucovorin; D011241:Prednisone; D008727:Methotrexate