Brain parenchyma involvement as isolated central nervous system relapse of systemic non-Hodgkin lymphoma: an International Primary CNS Lymphoma Collaborative Group report.
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.
Doolittle
Nancy D
ND
Department of Neurology, Oregon Health and Science University, Portland, OR 97239, USA. doolittl@ohsu.edu
Abrey
Lauren E
LE
Shenkier
Tamara N
TN
Tali
Siegal
S
Bromberg
Jacoline E C
JE
Neuwelt
Edward A
EA
Soussain
Carole
C
Jahnke
Kristoph
K
Johnston
Patrick
P
Illerhaus
Gerald
G
Schiff
David
D
Batchelor
Tracy
T
Montoto
Silvia
S
Kraemer
Dale F
DF
Zucca
Emanuele
E
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