title: Central nervous system involvement in T-cell lymphoma: A single center experience.
abstract: Background We characterized the incidence of central nervous system (CNS) involvement, risk factors and outcome in a large single institution dataset of peripheral T-cell lymphoma (PTCL). Methods Retrospective review of the PTCL database at Memorial Sloan Kettering Cancer Center. We identified 231 patients with any subtype of PTCL between 1994-2011 with a minimum six months of follow-up or an event defined as relapse or death. Results Histologies included peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) (31.6%), angioimmunoblastic (16.9%), anaplastic large cell lymphoma (ALCL), ALK- (12.1%), ALCL, ALK + (6.1%), extranodal NK/T-cell lymphoma (7.4%), adult T-cell leukemia/lymphoma (ATLL) (7.4%), and transformed mycosis fungoides (8.7%). Seventeen patients had CNS disease (7%). Fifteen had CNS involvement with PTCL and two had diffuse large B-cell lymphoma and glioblastoma. Median time to CNS involvement was 3.44 months (0.16-103.1). CNS prophylaxis was given to 24 patients (primarily intrathecal methotrexate). Rates of CNS involvement were not different in patients who received prophylaxis. Univariate analysis identified stage III-IV, bone marrow involvement, >1 extranodal site and ATLL as risk factors for CNS disease. On multivariate analysis, >1 extranodal site and international prognostic index (IPI) ≥ 3 were predictive for CNS involvement. The median survival of patients with CNS involvement was 2.63 months (0.10-75). Conclusions Despite high relapse rates, PTCL, except ATLL, carries a low risk of CNS involvement. Prognosis with CNS involvement is poor and risk factors include: >1 extra nodal site and IPI ≥3.
authors.affiliation: a Institute of Hematology, Rabin Medical Center , Petah-Tikva , Israel ;|b Sackler School of Medicine, Tel Aviv University , Tel Aviv , Israel ;
authors.forename: Ronit
authors.initials: R
authors.lastname: Gurion
authors.affiliation: c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , New York , USA ;|d Weill Cornell Medical College , New York , New York , USA ;
authors.forename: Neha
authors.initials: N
authors.lastname: Mehta
authors.affiliation: c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , New York , USA ;|d Weill Cornell Medical College , New York , New York , USA ;
authors.forename: Jocelyn C
authors.initials: JC
authors.lastname: Migliacci
authors.affiliation: c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , New York , USA ;|d Weill Cornell Medical College , New York , New York , USA ;
authors.forename: Andrew
authors.initials: A
authors.lastname: Zelenetz
authors.affiliation: c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , New York , USA ;|d Weill Cornell Medical College , New York , New York , USA ;
authors.forename: Alison
authors.initials: A
authors.lastname: Moskowitz
authors.affiliation: e Medical Oncology Service, Department of Medicine , University of Nebraska , Omaha , Nebraska , USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Lunning
authors.affiliation: c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , New York , USA ;|d Weill Cornell Medical College , New York , New York , USA ;
authors.forename: Craig
authors.initials: C
authors.lastname: Moskowitz
authors.affiliation: c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , New York , USA ;|d Weill Cornell Medical College , New York , New York , USA ;
authors.forename: Paul
authors.initials: P
authors.lastname: Hamlin
authors.affiliation: c Lymphoma Service, Department of Medicine , Memorial Sloan Kettering Cancer Center , New York , New York , USA ;|d Weill Cornell Medical College , New York , New York , USA ;
authors.forename: Steven
authors.initials: S
authors.lastname: Horwitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage / Q000627:therapeutic use*; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000453:epidemiology* / Q000473:pathology / Q000517:prevention & control; D003561:Cytarabine / Q000008:administration & dosage / Q000627:therapeutic use*; D005260:Female; D005909:Glioblastoma / Q000453:epidemiology / Q000473:pathology; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal; D045022:Lactate Dehydrogenases / Q000097:blood; D016403:Lymphoma, Large B-Cell, Diffuse / Q000453:epidemiology / Q000473:pathology; D016411:Lymphoma, T-Cell, Peripheral / Q000188:drug therapy / Q000453:epidemiology* / Q000473:pathology; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D008875:Middle Aged; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine; D045022:Lactate Dehydrogenases; C071195:D-lactate dehydrogenase; D008727:Methotrexate