Primary Cns Lymphoma : Neutrophil To Lymphocyte Ratio Predictive Of Survival

The aim of this study was to analyze the prognostic factors in cases of primary CNS lymphoma (PCNSL) treated at our centre. A retrospective review of case records of PCNSL cases treated at our institute between 2005 and 2016 was performed. The prognostic value of age, sex, Serum Albumin, Neutrophil Lymphocyte Ratio (NLR), were assessed with respect to overall survival. Atotal of 32 patients were included in the study. The median NLR of the study population was 3.6. It was observed that patients with a low NLR (NLR≤3.9) had a significantly better median overall survival compared to the high NLR group (NLR>3.9) [58 months vs 15 months; p=0.011]. We found that the NLR is a unique prognostic tool that predicts survival in PCNSL.

Two Cases of Treatment with Intrathecal Rituximab for Primary Central Nervous System Lymphoma / 대한내과학회지

Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin's lymphoma (NHL), usually composed of diffuse large B-cells. Although rituximab is known for its curative effect on B-cell NHL, data on the use of intrathecal rituximab for PCNSL are limited. In this report, we present two patients showing relapsed PCNSL with lymphomatous meningitis. Both patients were refractory to conventional methotrexate-based intrathecal chemotherapy. However, after intrathecal rituximab with or without conventional intrathecal chemotherapy, both patients showed stable disease on magnetic resonance brain imaging and cerebrospinal fluid analysis. There were no serious adverse events during each of 3 and 6 cycles with intrathecal rituximab immunotherapy.

Relapse pattern and prognostic factors for patients with primary central nervous system lymphoma / 대한혈액학회지

BACKGROUND: Primary central nervous system lymphoma (PCNSL) rarely relapses in extracranial sites, and no specialized guidelines for follow-up evaluation have been proposed. METHODS: We analyzed 65 patients with newly diagnosed PNCSL to evaluate the pattern of relapse and prognostic factors. RESULTS: Of the 65 patients analyzed, 55 had only parenchymal brain disease, and 10 had both intracranial and extracranial lesions. As a first-line treatment, 29 patients received chemotherapy only (CTx), 13 received chemotherapy followed by whole brain radiotherapy (CTx-WBRT), 18 received chemotherapy followed by autologous stem cell transplantation (CTx-ASCT), 2 received palliative WBRT, and 3 received best supportive care. The overall response rate to the initial treatment was 75.8%, with specific response rates of 62.1% to CTx, 84.6% to CTx-WBRT, and 100% to CTx-ASCT. The complete response (CR) rate was higher with CTx-ASCT than in the absence of ASCT (77.8% vs. 43.2%; P=0.025). After a median follow-up of 18.8 months, the median failure-free survival (FFS) and overall survival (OS) were 13.0 and 36.1 months, respectively. No systemic relapse without a CNS lesion was noted. Multivariate analysis showed that ASCT was predictive of better FFS but not of OS. Age and the Memorial-Sloan Kettering Cancer Center prognostic score were predictive of survival. CONCLUSION: We observed no systemic relapse without a CNS lesion, suggesting that regular systematic evaluation of extracranial sites may not always be necessary. Age was prognostic of survival irrespective of treatment scheme. ASCT may improve CR rate and FFS.

Successful Treatment of Primary Central Nervous System Lymphoma without Irradiation in Children: Single Center Experience

Primary CNS lymphoma (PCNSL) is a very uncommon disease in children, and usually treated by chemotherapy, combined with focal or craniospinal radiotherapy (RT). However, adverse effects of RT are a concern. We evaluated the outcomes of childhood PCNSL, treated with systemic and intrathecal chemotherapy, but without RT. For fifteen years, six patients among 175 of non-Hodgkin lymphoma were diagnosed as PCNSL in Seoul National University Children's Hospital and we analyzed their medical records retrospectively. Their male:female ratio was 5:1, and median age was 10.1 yr. The primary sites were the sellar area in three patients, parietal area in one, cerebellum in one, and multiple areas in one. Their pathologic diagnoses were diffuse large B-cell lymphoma in three patients, Burkitt lymphoma in two, and undifferentiated B-cell lymphoma in one. Five were treated with the LMB96 treatment protocol, and one was treated with the CCG-106B protocol. None had RT as a first-line treatment. One patient had a local relapse and received RT and salvage chemotherapy, without success. No patient had treatment-related mortality. Their estimated 5-yr event-free and overall survival rates were both 83.3%. In conclusion, PCNSL is a rare disease in childhood, but successfully treated by chemotherapy without RT.

Successful Treatment of Primary Central Nervous System Lymphoma without Irradiation in Children: Single Center Experience

Primary CNS lymphoma (PCNSL) is a very uncommon disease in children, and usually treated by chemotherapy, combined with focal or craniospinal radiotherapy (RT). However, adverse effects of RT are a concern. We evaluated the outcomes of childhood PCNSL, treated with systemic and intrathecal chemotherapy, but without RT. For fifteen years, six patients among 175 of non-Hodgkin lymphoma were diagnosed as PCNSL in Seoul National University Children's Hospital and we analyzed their medical records retrospectively. Their male:female ratio was 5:1, and median age was 10.1 yr. The primary sites were the sellar area in three patients, parietal area in one, cerebellum in one, and multiple areas in one. Their pathologic diagnoses were diffuse large B-cell lymphoma in three patients, Burkitt lymphoma in two, and undifferentiated B-cell lymphoma in one. Five were treated with the LMB96 treatment protocol, and one was treated with the CCG-106B protocol. None had RT as a first-line treatment. One patient had a local relapse and received RT and salvage chemotherapy, without success. No patient had treatment-related mortality. Their estimated 5-yr event-free and overall survival rates were both 83.3%. In conclusion, PCNSL is a rare disease in childhood, but successfully treated by chemotherapy without RT.

Imaging findings of CNS lymphoma in Siriraj Hospital.

Objective: To describe the CT and MR features of CNS lymphoma (both PCNSL and SLCNS groups) and to determine whether there is a difference. Methods: A retrospective study of CNS lymphoma in 100 patients at the department of Medicine, Siriraj Hospital, Mahidol University, during January 1997 – September 2002, for neuroimaging analysis. We retrospectively analyzed all available CT and MR findings of these patients by a neuroradiologist who was blinded to the patients’ clinical histories. The imaging studies were evaluated for density in CT, intensity in MR, pattern of enhancement, leptomeningeal enhancement, number of lesions, location and degree of edema. For MRI of spines, we additionally classified 4 menifestations: osseous lymphoma, spinal epidural lymphoma, lymphomatous meningitis and intramedullary lymphoma. Results: Only 33 CTs of the brain, 12 MRs of the brain and 11 MRs of spines were available for retrospective evaluation in this study. For CTs of the brain, most of the lesions showed hyperdensity on non-contrast CT (45% in PCNSL and 59% in SLCNS) with homogenous enhancement on contrast CT (78% in PCNSL and 75% in SLCNS). Eleven percent of ring enhancement lesions in PCNSL and eight percent in SLCNS were found in all patients with HIV infection. For MRs of the brain, most lesions of PCNSL and SLCNS showed hypo-isointensity in both T1W and T2W and homogenous enhancement. Locations of PCNSL were found in cerebral white matter and corpus callosum (55.5%) and basal ganglia (33.3%). SLCNS were found in cerebral white matter (50%), cavernous sinus (37.5%), basal ganglia (6.25%) and brainstems (6.25%). Conclusion: CNS lymphoma has been increased in Thailand. Imaging findings in PCNSL and SLCNS groups were not difference in this study. The pattern of imaging findings of CNS lymphoma in Thailand was similar to CNS lymphoma in the world.

A Case of Acute Respiratory Distress Syndrome by Nosocomial Mycoplasma Pneumonia Associated with Cold Agglutinin Disease in Primary CNS Lymphoma

Although Mycoplasma pneumonia is frequently observed in immunocompromized patient if, rarely results in acute respiratory distress syndrome (ARDS). The cold agglutinin is positive in 33-76% of patients with M. pneumonia infection. We experienced a case of ARDS due to mycoplasma pneumonia associated with cold agglutinin disease in primary CNS lymphoma. He was a 60-year old primary CNS lymphoma patient with mycoplasma pneumonia and cold agglutinin disease who rapidly progressed to ARDS after 1 cycle of chemotherapy. He completely recovered with roxithromycin, levofloxacin, and ventilator supports. After recovery 2nd cycle of combination chemotherapy and brain radiation therapy was given and, CNS lymphoma is in complete remission until now.

A Case of Acute Respiratory Distress Syndrome by Nosocomial Mycoplasma Pneumonia Associated with Cold Agglutinin Disease in Primary CNS Lymphoma

Although Mycoplasma pneumonia is frequently observed in immunocompromized patient if, rarely results in acute respiratory distress syndrome (ARDS). The cold agglutinin is positive in 33-76% of patients with M. pneumonia infection. We experienced a case of ARDS due to mycoplasma pneumonia associated with cold agglutinin disease in primary CNS lymphoma. He was a 60-year old primary CNS lymphoma patient with mycoplasma pneumonia and cold agglutinin disease who rapidly progressed to ARDS after 1 cycle of chemotherapy. He completely recovered with roxithromycin, levofloxacin, and ventilator supports. After recovery 2nd cycle of combination chemotherapy and brain radiation therapy was given and, CNS lymphoma is in complete remission until now.

A Case of Primary Lymphoma Presenting as Cauda Equina Syndrome

Primary CNS lymphoma (PCNSL) which is localized in the cauda equina of the spinal cord is very rare. A 75-year-old man had pain in both legs and gait disturbance for the last 45 days. Painful paresthesia and weakness in both legs worsened during a one month period and he was unable to stand up by himself. In a physical examination, lym-phadenopathy nor organomegaly was found. A neurological examination revealed a dominantly proximal muscle weak-ness of the lower extremities. All modalities of sensation were decreased in both legs and a Romberg test was found positive. A CSF cytology demonstrated a large B-cell lymphoma. Following an extensive evaluation of the patient, the lymphoma was found to be limited in the cauda equina. The patient was treated with systemic dexamethasone. After the treatment, his symptoms were improved and a follow up lumbar spine MRI showed shrunken cauda equina lesions.

Preirradiation Methotrexate, Radiation Therapy and Cytosine Arabinoside Chemotherapy in Primary Central Nervous System Lymphoma; Short-term Results

PURPOSE: Primary CNS lymphoma(PCNSL) is a rare brain tumor which has poor prognosis. It is sensitive to steroid or radiation therapy(RT), but the effect is transient. Recently, many centers have tried to increase survival rate and to lower recurrence rate by combined chemotherapy. Aim of this study is to investigate the response rate, performance status change and complications after combined modality treatment in our patients with PCNSL. PATIENTS AND METHODS:Fifteen consecutive PCNSL patients were included in this study. There was no immune compromized patient. All patients underwent pre-radiation systemic MTX, 1g/m 2, plus 6 doses of intrathecal MTX at 12mg per dose. Cranial RT(WBRT 40Gy, Boost 14.4Gy) was followed by two cycles of intravenous infusion of high dose cytarabine(Ara-C). We reviewed medical records, radiologic findings for evaluation of response and performance status. RESULTS: Seven patients completed this protocol. Response rate(CR + PR/total) after radiation and after completion of combined modality were 80% and 87%, respectively. No patients showed the decrease in performance status 20 more than pre-treatment status during treatment. Four CSF cytology positive patients had undergone all negative conversion after completion of intrathecal MTX chemotherapy. CONCLUSION: The addition of chemotherapy to cranial RT for initial treatment of PCNSL had favorable response rate, CSF cytology negative conversion rate, and maintaining performance status. But, we also have observed treatment failure including life threatening compications and non-responder. Therfore, careful monitoring of medical status should warranted and neuropsychological functions should also be evaluated.

Primary Intramedullary Spinal Cord Lymphoma: Case Report

The authors report a primary intramedullary spinal cord lymphoma in a 49-year-old man who presented with right arm pain, voiding difficulty and progressive walking difficulty. Preoperative cervical spinal CT and MRI studies were highly suggestive of spinal stenosis with compressive myelopathy but histopathological study of the specimen after surgery revealed spinal cord lymphoma. As no tumorous lesion was found other than the spinal cord, he was given 6000 rad of radiation under the diagnosis of primary CNS lymphoma. The neurologic deficits improved partially after the surgery but delete right arm pain persisted. One year later, follow up studies showed neither local nor systemic tumor recurrence.

Primary Central Nervous System Lymphoma / 대한암학회지

PURPOSE: Primary central nervous system lymphoma (PCNSL) is defined as lymphoma limited to the cranial-spinal axis without evidence of systemic disease and its incidence has risen threefold during the last fifteen years among apparantly healthy population. This study was intended to analyze the clinicopathologic features and treatment outcome of the patient with PCNSL. MATERIALS AND METHODS: Twenty one patients were diagnosed and treated for the PCNSL limited to brain parenchyme at Asan Medical Center between March 1989 and December 1996. We reviewed clinical records of these patients and analyzed clinicopathologic features, treatment response, survival time and prognostic factors. RESULTS: The ratio of male to female was 1.3: 1 and the most prevalent age group was the 4th decade. Most patients had diffuse large cell (19/21) and B-cell type (8/8). Seventeen (94.4%) among 18 evaluable patients achieved complete remission (CR) as initial response, but 53% of patients showed recurence of the disease. Median times of disease-free and overall survival were 40 and 50 months, respectively and 5 year overall survival rate was 35.3 %. Prognostic factors such as age and performance status, had a statistically significant influence on the overall survival but not on disease-free survival. CONCLUSION: CR rate of the patients with PCNSL was high, but relapses were frequent. There fore further studies are needed to define the pmgnostic factors and to decrease relapse rate.

Primary Central Nervous System Lymphoma Associated with Systemic Lymphoma: Case Report

Primary central nervous system(CNS) lymphoma is an uncommon neoplasm which is considered to be radiosensitive. We have recently experienced one of such cases with a history of systemic lymphoma(diffuse histiocytic lymphoma) of the left cheek and left forearm in a 56-year-old man. Chief complaints include headache and generalized weakness for 1 month. MRI(magnetic resonance imaging) revealed an enhancing irregular mass lesion in both the basal ganglia and corpus callosum with minimal surrounding brain edema. CSF analysis and cytology revealed no specific abnormal findings. Without brain biopsy, we concluded that the lesion was a primary CNS lymphoma based on the fact that the patient have had a history of diffuse histiocytic lymphoma and MRI findings were compatible to primary CNS lymphoma. He was treated with dexamethasone for 2 weeks and 3900 cGy radiation therapy for 5 weeks. He improved gradually, and control MRI after radiotherapy showed complete resolution of the lesion.