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Eleven patients presented with systemic as well as CNS localization, whereas in 55 patients,CNS relapse occurred later.The cumulative risk of CNS relapse at 4 years for all 532 patients was 19%.High grade NHL carried a 39%risk of CNS relapse,with the vast majority of relapses occurring in the first 14 months after initial diagnosis.The cumulative risk in patients with intermediate-grade NHL was considerable(22%)and dispersed throughout a much longer period(6 years).Patients with low grade NHL still carried a 7%risk of CNA relapse;in all these patients,low malignancy grade was transformed into a higher malignancy grade at that time.In a multivariate analysis,high and intermediate grade NHL and advanced stage were independent risk factors for CNS relapse.There was not any strong evidence for a beneficial role of CNS prophylaxis in patients with intermediate-grade and high-grade NHL,but a retrospective analysis cannot be conclusive with regard to the effect of therapy.Systemic relapse occurred rapidly after CNS relapse,resulting in a median survival time after CNS relapse of only two months.Patients with high and intermediate grade NHL carry a considerable risk of CNS relapse.Advanced stage is an additional independent risk factor.The role of CNS prophylaxis seems to be disappointing,but a retrospective analysis cannot be conclusive.Prognosis after CNS relapse is poor. |
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chemotherapy,CNS treatment and complications with
intrathecal chemotherapy
life expectancy
lymphoma
lymphoma involving CNS
lymphoma involving CNS,prophylactic treatment
neoplasm,primary of CNS-recurrent
neoplasm,primary of CNS-survival
neoplasm,primary of CNS-treatment of
prognosis
treatment of neurologic disorder
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