Antithrombin III is probably not a suitable biomarker for diagnosis of primary central nervous system lymphoma.

Risto Bloigu,Taina Turpeenniemi-Hujanen,Kirsi-Maria Haapasaari,Anne Marja Remes,Milla Elvi Linnea Kuusisto,Outi Kuittinen,Peeter Karihtala

doi:10.1007/s00277-015-2334-y

Abstract

Antithrombin III (AT III) in cerebrospinal fluid (CSF) has been suggested to have high specificity and sensitivity in separating primary central nervous system (CNS) lymphoma from other neurological conditions. We measured with ELISA CSF and serum AT III and albumin levels in 12 lymphoma patients with CNS involvement, 30 lymphoma patients without CNS involvement, and 41 patients with non-neoplastic neurological diseases. AT III immunostaining was also carried out, in lymphoma patients. Both CSF AT III and albumin levels were higher in lymphoma patients with CNS involvement. AT III/albumin ratio in CSF was the most sensitive and specific measure for diagnosis. Lowest it was in patients with known CNS lymphoma. Serum AT III levels were lower both in CNS lymphoma and systemic lymphoma. CSF AT III levels were shown to be higher in lymphoma patients with CNS involvement, when AT III/albumin ratios were lower. This was probably a result of lowered serum AT III levels, indicating that high levels of AT III in CSF might reflect only leakage of the blood–brain barrier. Thus, AT III fails to be a specific marker for diagnosis of lymphoma CNS involvement.

Highlights

About 2 % of all systemic lymphomas are primary central nervous system (CNS) lymphomas (PCNSLs)
When comparing Cerebrospinal fluid (CSF) Antithrombin III (AT III) concentrations in patients with PCNSL with those in patients with secondary CNS lymphoma or lymphoma patients without CNS lesions, or with the non-lymphoma group of patients, a statistically significant difference was seen indicating that CSF AT III concentrations were highest in the group of PCNSL patients (p=0.006)
Concentrations of CSF AT III were compared in patients with CNS lymphoma versus those with non-neoplastic neurological diseases

Summary

Introduction

About 2 % of all systemic lymphomas are primary central nervous system (CNS) lymphomas (PCNSLs). These are rapidly progressing diseases with often fatal outcome despite the use of high-dose methotrexate-containing treatment regimens [1]. The diagnosis of PCNSL is based on a histological sample taken by stereotactic biopsy. Sometimes in the early stage of the disease, there is no radiologically apparent target tissue for the biopsy or the disease may mimic another neurological disorders. The disease is rapidly progressing; there is a need for urgent diagnostic work-up and start of therapy. There is a need for sensitive and specific biomarkers for early diagnosis

Objectives

Methods

Results

Conclusion