involvement among patients with either Burkitt's or lymphoblastic lymphomas is considerable and ... Burkitt's lymphomas have an increased risk of CNS relapse.
Annals of Oncology 13: 1099–1107, 2002 DOI: 10.1093/annonc/mdf175
Original article
Central nervous system involvement following diagnosis of non-Hodgkin’s lymphoma: a risk model A. Hollender1*, S. Kvaloy1, O. Nome1, E. Skovlund1,2, K. Lote1 & H. Holte 1 1
Department of Medical Oncology and Radiotherapy, The Norwegian Radium Hospital, Oslo; 2Norwegian Medicines Agency, Oslo, Norway
Received 28 September 2001; revised 10 January 2002; accepted 11 February 2002
Background: To determine the incidence and risk factors for central nervous system (CNS) relapse in patients with non-Hodgkin’s lymphoma (NHL).
Patients and methods: Patient records were registered prospectively in successive patients with NHL admitted to the Norwegian Radium Hospital from 1980 to 1996. A total of 2514 patients had no CNS involvement at diagnosis and were treated according to standard protocols. The incidence and risk factors for CNS progression or relapse were examined retrospectively. Results: In low-grade (L)-NHL, the risk of CNS involvement was low (2.8%). In high-grade (H)-NHL, lymphoblastic and Burkitt’s NHL patients had a high risk of CNS recurrence (24.4%) at 5 years, and prophylaxis seemed to reduce this risk. For the other patients with H-NHL, the proportion with CNS involvement at 5 years was 5.2%. Multivariate analysis identified five independent risk factors, each present in >5% of patients: elevated serum lactate dehydrogenase, serum albumin 20 × 106/l in the CSF were also considered to have meningeal involvement. Among the 22 patients with intracerebral involvement, a biopsy to confirm the lymphoma diagnosis was only performed in one patient. Patients with CNSrelated symptoms, but whose results from MRI of the meninges and CSF examinations were normal or inconclusive, were regarded as clinically diagnosed CNS lymphoma. Other explanations such as CNS-associated infection, hemorrhage or infarction were excluded.
Table 1. Histology in 2514 consecutive patients with non-Hodgkin’s lymphoma (NHL) according to the Kiel classification [26] No. of patients (%) Low grade Follicular centroblastic/centrocytic + follicular Diffuse centroblastic/centrocytic Immunocytoma
1163 (46.3) 564 (22.5) 28 (1.1) 84 (3.3)
Lymphocytic
134 (5.3)
Centrocytic
116 (4.6)
Mycosis fungoides/Sezary syndrome Low-grade unclassified High grade
10 (0.4) 227 (9.1) 1220 (48.5)
Centroblastic
406 (16.1)
Immunoblastic
130 (5.2)
High-grade B-cell
237 (9.4)
Anaplastic large cell
101 (4.0)
Peripheral T-cell
121 (4.8)
High-grade unclassified
225 (8.9)
Lymphoblastic/Burkitt’s lymphoma
82 (3.3)
Lymphoblastic lymphoma
46 (1.8)
Burkitt’s lymphoma
36 (1.4)
NHL unspecified Total
49 (2) 2514 (100)
All the biopsies were classified according to the Kiel classification [24] in low-grade NHL (L-NHL) or high-grade NHL (H-NHL). Distribution of the various histological subtypes amongst the 2514 patients is shown in Table 1. Histological diagnosis was not reviewed specifically for this analysis, but the great majority of cases were diagnosed by one of two experienced hematopathologists.
1991. From 1987 most patients with lymphoblastic or Burkitt’s lymphoma in remission after induction chemotherapy were consolidated with high-dose therapy with purged autologous stem-cell support. One hundred and nineteen of the 141 patients receiving CNS prophylaxis were
