Elsevier

Annals of Oncology

Volume 13, Issue 7, July 2002, Pages 1099-1107
Annals of Oncology

Original article
Hematological malignancies
Central nervous system involvement following diagnosis ofnon-Hodgkin’s lymphoma: a risk model

https://doi.org/10.1093/annonc/mdf175Get rights and content
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Abstract

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 <35 g/l, <60 years of age, retroperitoneal lymph node involvement and involvement of more than one extranodal site. If four or five of these risk factors were present, the risk of CNS recurrence was in excess of 25% at 5 years.

Conclusions

The risk of CNS involvement in this study is comparable with the results from other large series. CNS prophylaxis is not recommended in any subgroup of L-NHL. The risk of CNS involvement among patients with either Burkitt’s or lymphoblastic lymphomas is considerable and these patients should therefore receive intensive chemotherapy including systemic and intrathecal methotrexate. Patients with other types of H-NHL should receive adequate CNS prophylaxis if at least four of the five risk factors identified are present.

Keywords

central nervous system involvement
central nervous system prophylaxis
non-Hodgkin’s lymphoma
risk factors

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