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Risk Factors, Treatment, and Outcome of Central Nervous System
Recurrence in Adults With Intermediate-Grade and Immunoblastic
Lymphoma
Koen van Besien,
Chul S. Ha,
Sandy Murphy,
Peter McLaughlin,
Alma Rodriguez,
Kamal Amin,
Arthur Forman,
Jorge Romaguera,
Fredrick Hagemeister,
Anas Younes,
Carlos Bachier,
Andreas Sarris,
Kathleen
S. Sobocinski,
James D. Cox, and
Fernando Cabanillas
From The Division of Medicine, Department of Hematology and
Neuro-oncology, and the Division of Radiation Oncology, MD Anderson
Cancer Center, Houston, TX; and The Statistical Center, International
Bone Marrow Transplant Registry, Medical College of Wisconsin,
Milwaukee, WI.
To evaluate the incidence, risk factors, and outcome of central
nervous system (CNS) recurrence in adult patients with non-Hodgkin's lymphoma, we evaluated 605 newly diagnosed patients with large-cell and
immunoblastic lymphoma who participated in prospective chemotherapy studies. The Kaplan-Meier estimate of probability of CNS recurrence at
1 year after diagnosis was 4.5% (95% confidence interval [CI], 4.4 to 4.6). Twenty-four patients developed CNS recurrence after a median
of 6 months from diagnosis (range, 0 to 44 months). In univariate
analysis, an increased risk for CNS recurrence was associated with an
advanced disease stage (P = .0014), an increased LDH
(P = .0000), the presence of B-symptoms (P = .0037), involvement of more than one extranodal site (P = .0000), poor performance status (P = .0005), and B-cell
phenotype (P = .008). Bone marrow involvement (P = .005), involvement of parenchymal organs (P = .03), and
involvement of skin, subcutaneous tissue, and muscle (P = .002) were also associated with an increased risk for CNS disease.
Multivariate logistic regression analysis identified only involvement
of more than one extranodal site (P = .0005) and an increased
LDH (P = .0008) as independent predictors of CNS recurrence.
Established CNS recurrence had a poor prognosis. Only 1 of 24 patients
remains alive and the Kaplan-Meier estimate of probability of survival
at 1 year after the diagnosis of CNS recurrence is only 25.3% (95%
CI, 6.9 to 43.7). Intrathecal treatment provided symptomatic benefit in
only 1 of 6 patients. Radiation treatment provided symptomatic
improvement in 6 of 9 patients treated. However, remissions were short
and followed by systemic or CNS recurrence. Serum LDH and involvement
of more than one extranodal site are independent risk factors for CNS
recurrence in patients with large-cell lymphoma. The presence of both
risk factors identifies a patient group at high risk for CNS
recurrence. Established CNS recurrence can be rapidly fatal. Transient
responses occur after radiation treatment.
Blood, Vol. 91 No. 4 (February 15), 1998:
pp. 1178-1184
© 1998 by The American Society of Hematology.
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