Abstract
6718 Background: The prognosis of patients with non-Hodgkin’s lymphoma (NHL) and central nervous system (CNS) involvement is generally regarded as poor. Very little is known about prognostic factors in these patients. The aim of this retrospective single-center study was to analyze the clinical characteristics and outcome of NHL patients with CNS involvement and identify prognostic factors for survival. Methods: We searched our hospital records for NHL patients with CNS involvement diagnosed from 1982 to 2003, and 43 were identified. Prognostic factors for survival were assessed by univariate and multivariate analysis. Results: The median age at CNS manifestation was 61 (range, 22–87); the median Karnofsky performance status was 55 (range 10–90). Thirty-five patients had CNS relapse and 8 patients CNS involvement at first presentation. Isolated CNS disease was found in 6 patients and concomitant systemic disease in 36. Initial management included systemic chemotherapy (n=25), chemo-/radiotherapy (n=16), dexamethasone (n=1), and no treatment (n=1). Chemotherapy consisted of CNS-penetrating drugs (high-dose methotrexate or ifosfamide) in 24 patients. Intrathecal chemotherapy was given to 34 patients. Twenty-six patients showed a CNS response. The median survival from the time of CNS manifestation and the median overall survival (OAS) were 5.5 (0–82.5+) and 37 (0–181) months, respectively. Lactate dehydrogenase (LDH) at CNS manifestation (p = .051) and CNS response to therapy were identified as independent prognostic factors for survival on multivariate analysis (p = <.001), whereas age at initial diagnosis, initial CNS involvement, initial LDH, and treatment with CNS-penetrating chemotherapy for CNS involvement were only significant on univariate analysis. All but one of 9 patients who are still alive received substances able to sufficiently penetrate the blood-brain barrier. All survivors were disease-free at the last follow-up. Conclusions: Long-term survival can be achieved in patients with NHL and CNS involvement. LDH at CNS manifestation and CNS response to therapy were significantly associated with survival. No significant financial relationships to disclose.
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