title: Brain parenchyma involvement as isolated central nervous system relapse of systemic non-Hodgkin lymphoma: an International Primary CNS Lymphoma Collaborative Group report.
abstract: Isolated central nervous system (CNS) relapse involving the brain parenchyma is a rare complication of systemic non-Hodgkin lymphoma. We retrospectively analyzed patient characteristics, management, and outcomes of this complication. After complete response to initial non-Hodgkin lymphoma treatment, patients with isolated CNS relapse with the brain parenchyma as initial relapse site were eligible. Patients with isolated CNS relapse involving only the cerebrospinal fluid were not eligible. Information on 113 patients was assembled from 13 investigators; 94 (83%) had diffuse large B-cell lymphoma. Median time to brain relapse was 1.8 years (range, 0.25-15.9 years). Brain relapse was identified by neuroimaging in all patients; in 54 (48%), diagnostic brain tumor specimen was obtained. Median overall survival from date of brain relapse was 1.6 years (95% confidence interval, 0.9-2.6 years); 26 (23%) have survived 3 years or more. Median time to progression was 1.0 year (95% confidence interval, 0.7-1.7 years). Age less than 60 years (P = .006) at relapse and methotrexate use (P = .008) as front-line treatment for brain relapse were significantly associated with longer survival in a multivariate model. Our results suggest systemic methotrexate is the optimal treatment for isolated CNS relapse involving the brain parenchyma. Long-term survival is possible in some patients.
authors.affiliation: Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA. doolittl@ohsu.edu
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Doolittle
authors.forename: Lauren E
authors.initials: LE
authors.lastname: Abrey
authors.forename: Tamara N
authors.initials: TN
authors.lastname: Shenkier
authors.forename: Siegal
authors.initials: S
authors.lastname: Tali
authors.forename: Jacoline E C
authors.initials: JE
authors.lastname: Bromberg
authors.forename: Edward A
authors.initials: EA
authors.lastname: Neuwelt
authors.forename: Carole
authors.initials: C
authors.lastname: Soussain
authors.forename: Kristoph
authors.initials: K
authors.lastname: Jahnke
authors.forename: Patrick
authors.initials: P
authors.lastname: Johnston
authors.forename: Gerald
authors.initials: G
authors.lastname: Illerhaus
authors.forename: David
authors.initials: D
authors.lastname: Schiff
authors.forename: Tracy
authors.initials: T
authors.lastname: Batchelor
authors.forename: Silvia
authors.initials: S
authors.lastname: Montoto
authors.forename: Dale F
authors.initials: DF
authors.lastname: Kraemer
authors.forename: Emanuele
authors.initials: E
authors.lastname: Zucca
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001932:Brain Neoplasms / Q000556:secondary* / Q000601:surgery / Q000628:therapy; D016543:Central Nervous System Neoplasms / Q000556:secondary*; D002543:Cerebral Hemorrhage; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000145:classification / Q000473:pathology* / Q000601:surgery / Q000628:therapy; D008297:Male; D008875:Middle Aged; D012008:Recurrence