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Treatment of CNS dissemination in systemic lymphoma

  • Imagers in Neuron-Oncology Clinical-Patient Studies
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Summary

The frequency of central nervous system (CNS) dissemination in non-Hodgkin’s lymphoma (NHL) varies and is dependent on NHL histology. More than 50% of patients with CNS involvement have advanced and progressive systemic disease. While CNS involvement at initial diagnosis may be treated curatively, treatment of CNS involvement in systemic relapsing or refractory lymphoma is challenging and most often palliative. Due to a paucity of randomized trials, treatment of lymphomatous metastases is not standardized. Nonetheless, treatment of LM entails administration of both CNS-directed and systemic chemotherapy that often includes high-dose chemotherapy regimens with stem cell support.

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References

  1. Bollen EL, Brouwer RE, Hamers S et al (1997) Central nervous system relapse in non-Hodgkin lymphoma. A single-center study of 532 patients. Arch Neurol 54:854–859

    PubMed  CAS  Google Scholar 

  2. Feugier P, Virion JM, Tilly H et al. (2004) Incidence and risk factors for central nervous system occurrence in elderly patients with diffuse large-B-cell lymphoma: influence of rituximab. Ann Oncol 15:129–133

    Article  PubMed  CAS  Google Scholar 

  3. Fonseca R, Habermann TM, Colgan JP et al (2000) Testicular lymphoma is associated with a high incidence of extranodal recurrence. Cancer 88:154–161

    Article  PubMed  CAS  Google Scholar 

  4. Herman TS, Hammond N, Jones SE et al (1979) Involvement of the central nervous system by non-Hodgkin’s lymphoma: the Southwest Oncology Group experience. Cancer 43:390–397

    Article  PubMed  CAS  Google Scholar 

  5. Hollender A, Kvaloy S, Nome O et al (2002) Central nervous system involvement following diagnosis of non-Hodgkin’s lymphoma: a risk model. Ann Oncol 13:1099–1107

    Article  PubMed  CAS  Google Scholar 

  6. Jahnke K, Thiel E, Martus P et al (2006) Retrospective study of prognostic factors in non-Hodgkin lymphoma secondarily involving the central nervous system. Ann Hematol 85:45–50

    Article  PubMed  Google Scholar 

  7. Zucca E, Conconi A, Mughal TI et al (2003) Patterns of outcome and prognostic factors in primary large-cell lymphoma of the testis in a survey by the International Extranodal Lymphoma Study Group. J Clin Oncol 21:20–27

    Article  PubMed  CAS  Google Scholar 

  8. Hollender A, Kvaloy S, Lote K et al (2000) Prognostic factors in 140 adult patients with non-Hodgkin’s lymphoma with systemic central nervous system (CNS) involvement. A single centre analysis. Eur J Cancer 36:1762–1768

    CAS  Google Scholar 

  9. Recht L, Straus DJ, Cirrincione C et al (1988) Central nervous system metastases from non-Hodgkin’s lymphoma: treatment and prophylaxis. Am J Med 84:425–435

    Article  PubMed  CAS  Google Scholar 

  10. Tondini C, Ferreri AJ, Siracusano L et al (1999) Diffuse large-cell lymphoma of the testis. J Clin Oncol 17:2854–2858

    PubMed  CAS  Google Scholar 

  11. Hasselblom S, Ridell B, Wedel H et al (2004) Testicular lymphoma–a retrospective, population-based, clinical and immunohistochemical study. Acta Oncol 43:758–765

    Article  PubMed  Google Scholar 

  12. Zinzani PL, Magagnoli M, Frezza G et al (1999) Isolated central nervous system relapse in aggressive non-Hodgkin’s lymphoma: the Bologna experience. Leuk Lymphoma 32:571–576

    PubMed  CAS  Google Scholar 

  13. Tomita N, Kodama F, Kanamori H et al (2002) Prophylactic intrathecal methotrexate and hydrocortisone reduces central nervous system recurrence and improves survival in aggressive non-hodgkin lymphoma. Cancer 95:576–580

    Article  PubMed  CAS  Google Scholar 

  14. Haddy TB, Adde MA, Magrath IT (1991) CNS involvement in small noncleaved-cell lymphoma: is CNS disease per se a poor prognostic sign? J Clin Oncol 9:1973–1982

    PubMed  CAS  Google Scholar 

  15. Haioun C, Besson C, Lepage E et al (2000) Incidence and risk factors of central nervous system relapse in histologically aggressive non-Hodgkin’s lymphoma uniformly treated and receiving intrathecal central nervous system prophylaxis: a GELA study on 974 patients. Groupe d’Etudes des Lymphomes de l’Adulte. Ann Oncol 11:685–690

    Article  PubMed  CAS  Google Scholar 

  16. Ersboll J, Schultz HB, Thomsen BL et al (1985) Meningeal involvement in non-Hodgkin’s lymphoma: symptoms, incidence, risk factors and treatment. Scand J Haematol 35:487–496

    Article  PubMed  CAS  Google Scholar 

  17. Yoshida S, Morii K, Watanabe M et al (2000) Characteristic features of malignant lymphoma with central nervous system involvement. Surg Neurol 53:163–167

    Article  PubMed  CAS  Google Scholar 

  18. Bokstein F, Lossos A, Lossos IS et al (2002) Central nervous system relapse of systemic non-Hodgkin’s lymphoma: results of treatment based on high-dose methotrexate combination chemotherapy. Leuk Lymphoma 43:587–593

    Article  PubMed  CAS  Google Scholar 

  19. Johnson GJ, Oken MM, Anderson JR et al (1984) Central nervous system relapse in unfavourable-histology non-Hodgkin’s lymphoma: is prophylaxis indicated? Lancet 2:685–687

    Article  PubMed  CAS  Google Scholar 

  20. MacKintosh FR, Colby TV, Podolsky WJ et al (1982) Central nervous system involvement in non-Hodgkin’s lymphoma: an analysis of 105 cases. Cancer 49:586–595

    Article  PubMed  CAS  Google Scholar 

  21. Tilly H, Lepage E, Coiffier B et al (2003) Intensive conventional chemotherapy (ACVBP regimen) compared with standard CHOP for poor-prognosis aggressive non-Hodgkin lymphoma. Blood 102:4284–4289

    Article  PubMed  CAS  Google Scholar 

  22. Spectre G, Gural A, Amir G et al (2005) Central nervous system involvement in indolent lymphomas. Ann Oncol 16:450–454

    Article  PubMed  CAS  Google Scholar 

  23. Anselmo AP, Proia A, Cartoni C et al (1996) Meningeal localization in a patient with Hodgkin’s disease. Description of a case and review of the literature. Ann Oncol 7:1071–1075

    PubMed  CAS  Google Scholar 

  24. Boehme V, Zeynalova S, Kloess M, Leoffler M, Pfreunschuh M, Schmitz N (2007) Incidence and risk factors of central nervous system recurrence in aggressive NHL - a survey of 1693 patients treated in protocols of the German High-Grade Lymphoma Study Group (DSNHL). Ann Oncol 18(1):149–157

    Article  PubMed  CAS  Google Scholar 

  25. Skarin AT, Canellos GP, Rosenthal DS et al (1983) Improved prognosis of diffuse histiocytic and undifferentiated lymphoma by use of high dose methotrexate alternating with standard agents (M-BACOD). J Clin Oncol 1:91–98

    PubMed  CAS  Google Scholar 

  26. Brachet C, Dufrane JP, Van De Casseye M et al (2000) [Bilateral breast masses]. Rev Med Brux 21:165–169

    PubMed  CAS  Google Scholar 

  27. Restrepo A, Raez LE, Byrne GE Jr. et al (1998) Is central nervous system prophylaxis necessary in ocular adnexal lymphoma? Crit Rev Oncog 9:269–273

    PubMed  CAS  Google Scholar 

  28. Montserrat E, Bosch F, Lopez-Guillermo A et al (1996) CNS involvement in mantle-cell lymphoma. J Clin Oncol 14:941–944

    PubMed  CAS  Google Scholar 

  29. Valdez R, Kroft SH, Ross CW et al (2002) Cerebrospinal fluid involvement in mantle cell lymphoma. Mod Pathol 15:1073–1079

    Article  PubMed  Google Scholar 

  30. Hegde U, Filie A, Little RF et al (2005) High incidence of occult leptomeningeal disease detected by flow cytometry in newly diagnosed aggressive B-cell lymphomas at risk for central nervous system involvement: the role of flow cytometry versus cytology. Blood 105:496–502

    Article  PubMed  CAS  Google Scholar 

  31. Shapiro WR, Young DF, Mehta BM (1975) Methotrexate: distribution in cerebrospinal fluid after intravenous, ventricular and lumbar injections. N Engl J Med 293:161–166

    Article  PubMed  CAS  Google Scholar 

  32. Anghel G, Petrinato G, Severino A et al (2003) Intravascular B-cell lymphoma: report of two cases with different clinical presentation but rapid central nervous system involvement. Leuk Lymphoma 44:1353–1359

    Article  PubMed  CAS  Google Scholar 

  33. Ferreri AJ, Campo E, Ambrosetti A et al (2004) Anthracycline-based chemotherapy as primary treatment for intravascular lymphoma. Ann Oncol 15:1215–1221

    Article  PubMed  CAS  Google Scholar 

  34. Gokbuget N, Hoelzer D (1998) Meningeosis leukaemica in adult acute lymphoblastic leukaemia. J Neurooncol 38:167–180

    Article  PubMed  CAS  Google Scholar 

  35. Sariban E, Edwards B, Janus C et al (1983) Central nervous system involvement in American Burkitt’s lymphoma. J Clin Oncol 1:677–681

    PubMed  CAS  Google Scholar 

  36. Perez-Soler R, Smith TL, Cabanillas F (1986) Central nervous system prophylaxis with combined intravenous and intrathecal methotrexate in diffuse lymphoma of aggressive histologic type. Cancer 57:971–977

    Article  PubMed  CAS  Google Scholar 

  37. Teshima T, Akashi K, Shibuya T et al (1990) Central nervous system involvement in adult T-cell leukemia/lymphoma. Cancer 65:327–332

    Article  PubMed  CAS  Google Scholar 

  38. van BK, Ha CS, Murphy S et al (1998) Risk factors, treatment, and outcome of central nervous system recurrence in adults with intermediate-grade and immunoblastic lymphoma. Blood 91:1178–1184

  39. Glantz MJ, Hoffman JM, Coleman RE et al (1991) Identification of early recurrence of primary central nervous system tumors by (18F)fluorodeoxyglucose positron emission tomography. Ann Neurol 29:347–355

    Article  PubMed  CAS  Google Scholar 

  40. Glass JP, Melamed M, Chernik NL et al (1979) Malignant cells in cerebrospinal fluid (CSF): the meaning of a positive CSF cytology. Neurology 29:1369–1375

    PubMed  CAS  Google Scholar 

  41. French CA, Dorfman DM, Shaheen G et al (2000) Diagnosing lymphoproliferative disorders involving the cerebrospinal fluid: increased sensitivity using flow cytometric analysis. Diagn Cytopathol 23:369–374

    Article  PubMed  CAS  Google Scholar 

  42. Gleissner B, Siehl J, Korfel A et al (2002) CSF evaluation in primary CNS lymphoma patients by PCR of the CDR III IgH genes. Neurology 58:390–396

    PubMed  CAS  Google Scholar 

  43. Litam JP, Cabanillas F, Smith TL et al (1979) Central nervous system relapse in malignant lymphomas: risk factors and implications for prophylaxis. Blood 54:1249–1257

    PubMed  CAS  Google Scholar 

  44. Glantz MJ, Chamberlain MC, Batchelor T, Eric W, Cavalli F, Shapiro WR (2006) Interaction between route of intra-CSF chemotherapy administration and efficacy of therapy in patients with neoplastic meningitis. J Clin Oncol 24:1530a

    Google Scholar 

  45. Strong JM, Collins JM, Lester C et al (1986) Pharmacokinetics of intraventricular and intravenous N,N′,N′′-triethylenethiophosphoramide (thiotepa) in rhesus monkeys and humans. Cancer Res 46:6101–6104

    PubMed  CAS  Google Scholar 

  46. Grossman SA, Finkelstein DM, Ruckdeschel JC et al (1993) Randomized prospective comparison of intraventricular methotrexate and thiotepa in patients with previously untreated neoplastic meningitis. Eastern Cooperative Oncology Group. J Clin Oncol 11:561–569

    PubMed  CAS  Google Scholar 

  47. Glantz MJ, LaFollette S, Jaeckle KA et al (1999) Randomized trial of a slow-release versus a standard formulation of cytarabine for the intrathecal treatment of lymphomatous meningitis. J Clin Oncol 17:3110–3116

    PubMed  CAS  Google Scholar 

  48. Glantz MJ, Cole BF, Recht L et al (1998) High-dose intravenous methotrexate for patients with nonleukemic leptomeningeal cancer: is intrathecal chemotherapy necessary? J Clin Oncol 16:1561–1567

    PubMed  CAS  Google Scholar 

  49. Cheng AL, Yeh KH, Uen WC et al (1998) Systemic chemotherapy alone for patients with non-acquired immunodeficiency syndrome-related central nervous system lymphoma: a pilot study of the BOMES protocol. Cancer 82:1946–1951

    Article  PubMed  CAS  Google Scholar 

  50. Williams CD, Pearce R, Taghipour G et al (1994) Autologous bone marrow transplantation for patients with non-Hodgkin’s lymphoma and CNS involvement: those transplanted with active CNS disease have a poor outcome–a report by the European Bone Marrow Transplant Lymphoma Registry. J Clin Oncol 12:2415–2422

    PubMed  CAS  Google Scholar 

  51. Alvarnas JC, Negrin RS, Horning SJ et al (2000) High-dose therapy with hematopoietic cell transplantation for patients with central nervous system involvement by non-Hodgkin’s lymphoma. Biol Blood Marrow Transplant 6:352–358

    Article  PubMed  CAS  Google Scholar 

  52. Kasamon YL, Jones RJ, Piantadosi S et al (2005) High-dose therapy and blood or marrow transplantation for non-Hodgkin lymphoma with central nervous system involvement. Biol Blood Marrow Transplant 11:93–100

    Article  PubMed  CAS  Google Scholar 

  53. Kim S, Kim DJ, Geyer MA et al (1987) Multivesicular liposomes containing 1-beta-D-arabinofuranosylcytosine for slow-release intrathecal therapy. Cancer Res 47:3935–3937

    PubMed  CAS  Google Scholar 

  54. Shapiro WR, Schmid M, Glantz M, Miller JJ (2006) A randomized phase III/IV study to determine benefit and safety of cytarabine liposome injection for treatment of neoplastic meningitis. J Clin Oncol 24:1528a

    Article  CAS  Google Scholar 

  55. Rubenstein JL, Combs D, Rosenberg J et al (2003) Rituximab therapy for CNS lymphomas: targeting the leptomeningeal compartment. Blood 101:466–468

    Article  PubMed  CAS  Google Scholar 

  56. Chamberlain MC, Tsao-Wei DD, Groshen S (2006) Phase II trial of intracerebrospinal fluid etoposide in the treatment of neoplastic meningitis. Cancer 106:2021–2027

    Article  PubMed  CAS  Google Scholar 

  57. Thyss A, Milano G, Deville A et al (1987) Effect of dose and repeat intravenous 24 hr infusions of methotrexate on cerebrospinal fluid availability in children with hematological malignancies. Eur J Cancer Clin Oncol 23:843–847

    Article  PubMed  CAS  Google Scholar 

  58. Milano G, Thyss A, Serre DF et al (1990) CSF drug levels for children with acute lymphoblastic leukemia treated by 5 g/m2 methotrexate. A study from the EORTC Children’s Leukemia Cooperative Group. Eur J Cancer 26:492–495

    Article  PubMed  CAS  Google Scholar 

  59. Millot F, Rubie H, Mazingue F et al (1994) Cerebrospinal fluid drug levels of leukemic children receiving intravenous 5 g/m2 methotrexate. Leuk Lymphoma 14:141–144

    PubMed  CAS  Google Scholar 

  60. Frick J, Ritch PS, Hansen RM et al (1984) Successful treatment of meningeal leukemia using systemic high-dose cytosine arabinoside. J Clin Oncol 2:365–368

    PubMed  CAS  Google Scholar 

  61. Delgado J, Canales MA, Garcia B et al (2002) Radiation therapy and combination of cladribine, cyclophosphamide, and prednisone as treatment of Bing-Neel syndrome: case report and review of the literature. Am J Hematol 69:127–131

    Article  PubMed  CAS  Google Scholar 

  62. McLaughlin P, Velasquez WS, Redman JR et al (1988) Chemotherapy with dexamethasone, high-dose cytarabine, and cisplatin for parenchymal brain lymphoma. J Natl Cancer Inst 80:1408–1412

    Article  PubMed  CAS  Google Scholar 

  63. McMillan A (2005) Central nervous system-directed preventative therapy in adults with lymphoma. Br J Haematol 131:13–21

    Article  PubMed  CAS  Google Scholar 

  64. Hryniuk WM, Bertino JR (1969) Treatment of leukemia with large doses of methotrexate and folinic acid: clinical-biochemical correlates. J Clin Invest 48:2140–2155

    Article  PubMed  CAS  Google Scholar 

  65. Kimelberg HK, Kung D, Watson RE et al (1978) Direct administration of methotrexate into the central nervous system of primates. Part 1: Distribution and degradation of methotrexate in nervous and systemic tissue after intraventricular injection. J Neurosurg 48:883–894

    Article  PubMed  CAS  Google Scholar 

  66. Olson JJ, Blakely JO, Grossman SA, Weingart J, Rashid A, Supko J (2006) Differences in the distribution of methotrexate into high grade gliiomas following intravenous administration, as monitored by microdialysis, are associated with blood brain barrier integrity. J Clin Oncol 24(18S):1548a

    Google Scholar 

  67. Bleyer WA (1981) Neurologic sequelae of methotrexate and ionizing radiation: a new classification. Cancer Treat Rep 65(Suppl 1):89–98

    PubMed  Google Scholar 

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Acknowledgement

We thank Michael Pfreundschuh for kindly reviewing the manuscript.

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Correspondence to B. Gleissner.

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Gleissner and Chamberlain contributed equally.

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Gleissner, B., Chamberlain, M. Treatment of CNS dissemination in systemic lymphoma. J Neurooncol 84, 107–117 (2007). https://doi.org/10.1007/s11060-007-9353-z

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