CNS Infiltration: A Complication of Diffuse Lymphomas

Abstract

With the introduction of more aggressive and successful therapies for the non-Hodgkin’s lymphomas, survival has improved for many patients with varied histological patterns (DeVita et al., 1975; Portlock and Rosenberg, 1977) and neurological complications, once thought to be uncommon (Sparling et al., 1948; Williams et al., 1959), have been seen with increasing frequency. The frequency of lymphomatous involvement of the central nervous system (CNS) has been estimated at less than 5 per cent in several earlier large reviews of lymphomas (Mullins et al., 1971; Venty, 1968). However, more recent analyses have focused on high-risk populations and have reported frequencies as high as 29 per cent (Bunn et al., 1976). The use of the Rappaport classification (Rappaport, 1966) has allowed the characterisation of the non-Hodgkin’s lymphomas into relatively distinct groups with quite varied natural histories, and has identified patients with diffuse histological patterns as those at highest risk for CNS complications (Griffin et al., 1971; Gendleman et al. 1969; Olson et al., 1974). With the apparent increase in this serious complication and with its particular association with distinct histologies, there has been interest in the possibility of prophylactic therapy to the CNS in an effort to eliminate CNS recurrence.