High-dose intravenous methotrexate followed by autologous stem cell transplantation as a potentially effective therapy for neurolymphomatosis.
BACKGROUND
Neurolymphomatosis (NL) is a rare neurologic manifestation of systemic lymphoma characterized by lymphomatous infiltration of the peripheral nervous system. The diagnosis of NL is difficult and requires a multidisciplinary approach for obtaining an adequate biopsy specimen of the suspected nerve. The prognosis of patients with NL has been poor because adequate penetration of chemotherapy into the nervous system is difficult.


METHODS
The authors presented the case of a 37-year-old man who was treated for Ann Arbor Stage IVB diffuse large B-cell lymphoma. The patient developed disease recurrence in the sciatic nerve without systemic involvement.


RESULTS
The patient achieved a clinical response after receipt of high-dose intravenous methotrexate followed by high-dose chemotherapy and autologous stem cell transplant.


CONCLUSIONS
The authors reported this case to highlight the effectiveness of this regimen in a rare and fatal disorder. In the current study they also reviewed the literature regarding the diagnosis, prognosis, and treatment of NL.
Ghobrial
Irene M
IM
Division of Hematology, Department of Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA.
Buadi
Francis
F
Spinner
Robert J
RJ
Colgan
Joseph P
JP
Wolanskyj
Alexandra P
AP
Dyck
P James
PJ
Witzig
Thomas E
TE
Micallef
Ivana N
IN
O'Neill
Brian Patrick
BP
D000328:Adult; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D001717:Birds; D003131:Combined Modality Therapy; D006801:Humans; D007262:Infusions, Intravenous; D016393:Lymphoma, B-Cell / Q000473:pathology / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000627:therapeutic use*; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology / Q000628:therapy*; D012584:Sciatic Nerve / Q000473:pathology; D033581:Stem Cell Transplantation; D014182:Transplantation, Autologous
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate