title: Mantle cell lymphoma with central nervous system involvement: frequency and clinical features.
abstract: Reported rates of central nervous system (CNS) involvement in mantle cell lymphoma (MCL) are highly variable but substantial (4-26%). Data is lacking regarding risk factors for CNS relapse, and for those patients in whom CNS prophylaxis could be beneficial. We present single institution retrospective analysis of data of baseline features, clinical course, rate of CNS disease and putative risk factors in 62 patients with MCL (18 female, 44 male). CNS disease (all cases were symptomatic) occurred in four patients at a median of 12 months (range 1-58) from diagnosis, with a crude incidence of 6.5% and 5-year actuarial incidence of 5 +/- 3%. Two cases had blastic MCL at diagnosis. Survival after CNS relapse ranged from 2-9 months. Patients who developed CNS disease had a significantly shorter survival from diagnosis than those who did not (P = 0.0024). Symptomatic CNS disease in patients with MCL either at presentation or relapse is an uncommon but devastating complication. In younger patients, more aggressive immuno-chemotherapy regimens containing CNS-penetrating agents may reduce the incidence of CNS disease. While not routinely justified for all patients, CNS prophylaxis may particularly benefit patients with blastic histology at diagnosis, or those with systemic relapse after first-line treatment.
authors.affiliation: Department of Haematology and Medical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Saar
authors.initials: S
authors.lastname: Gill
authors.forename: Kirsten E
authors.initials: KE
authors.lastname: Herbert
authors.forename: H Miles
authors.initials: HM
authors.lastname: Prince
authors.forename: Max M
authors.initials: MM
authors.lastname: Wolf
authors.forename: Andrew
authors.initials: A
authors.lastname: Wirth
authors.forename: Gail
authors.initials: G
authors.lastname: Ryan
authors.forename: Dennis A
authors.initials: DA
authors.lastname: Carney
authors.forename: David S
authors.initials: DS
authors.lastname: Ritchie
authors.forename: John M
authors.initials: JM
authors.lastname: Davies
authors.forename: John F
authors.initials: JF
authors.lastname: Seymour
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000517:prevention & control; D004812:Epidemiologic Methods; D005260:Female; D006801:Humans; D020522:Lymphoma, Mantle-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome