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Nervous System Lymphoma (nervous + system_lymphoma)
Kinds of Nervous System Lymphoma Selected AbstractsEBV-Associated Leukoencephalopathy with Late Onset of Central Nervous System Lymphoma in a Kidney Transplant RecipientAMERICAN JOURNAL OF TRANSPLANTATION, Issue 4 2010A. Vaglio Central nervous system (CNS) lymphoma is a rare posttransplant lymphoproliferative disorder (PTLD), which usually has a poor outcome. To date, no specific conditions predisposing to this complication have been identified. We here describe the case of a renal transplant patient who was initially diagnosed as having Epstein-Barr virus (EBV)-associated leukoencephalopathy and ultimately developed EBV-positive CNS lymphoma. The patient was a young lady who, 2 years after transplantation, presented with focal neurological and electroencephalographic abnormalities and diffuse white matter lesions on brain magnetic resonance imaging. EBV-DNA was detected in the cerebrospinal fluid (CSF) by polymerase chain reaction. After acyclovir therapy and immunosuppressive drug tapering, the symptoms and electroencephalographic abnormalities subsided, and EBV-DNA disappeared from the CSF. Ten years later, a bulky cerebral mass was found. After excision, a diagnosis of EBV-positive, Hodgkin-like monomorphic B-cell PTLD was made. This case illustrates the potential pathophysiological relationships between EBV infection, leukoencephalopathy and CNS lymphoma; although a long time elapsed from the initial neurological illness to CNS lymphoma, a link between these two conditions cannot be excluded. Therefore, a careful long-term follow-up of EBV-related encephalopathy is advisable. [source] Eccentric target sign in cerebral toxoplasmosis: Neuropathological correlate to the imaging feature,JOURNAL OF MAGNETIC RESONANCE IMAGING, Issue 6 2010G.G. Sharath Kumar MD Abstract Cerebral toxoplasmosis remains one of the most common focal brain lesions in patients with acquired immune deficiency syndrome (AIDS). Diagnosis is a challenge because on cranial imaging it closely mimics central nervous system lymphoma, primary and metastatic central nervous system (CNS) tumors, or other intracranial infections like tuberculoma or abscesses. A magnetic resonance imaging (MRI) feature on postcontrast T1-weighted sequences considered pathognomonic of toxoplasmosis is the "eccentric target sign." The pathological correlate of this imaging sign has been speculative. Herein we correlate the underlying histopathology to the MR feature of eccentric target sign in a patient with autopsy-proven HIV/AIDS-related cerebral toxoplasmosis. The central enhancing core of the target seen on MRI was produced by a leash of inflamed vessels extending down the length of the sulcus that was surrounded by concentric zones of necrosis and a wall composed of histiocytes and proliferating blood vessels, with impaired permeability producing the peripheral enhancing rim. J. Magn. Reson. Imaging 2010;31:1469,1472. © 2010 Wiley-Liss, Inc. [source] Long-term survival with favorable cognitive outcome after chemotherapy in primary central nervous system lymphomaANNALS OF NEUROLOGY, Issue 2 2010Annika Juergens MD Objective To evaluate long-term progression-free survival and overall survival, quality of life, and cognitive function in primary central nervous system lymphoma after systemic and intraventricular chemotherapy without radiotherapy. Methods A long-term follow-up was conducted on surviving primary central nervous system lymphoma patients having been enrolled in a pilot/phase II trial between September 1995 and December 2001. Initially, 65 patients (median age, 62 years) had been treated with systemic and intraventricular chemotherapy without radiotherapy. All living patients were contacted, and a neurological examination, comprehensive neuropsychological testing, quality-of-life assessment, and imaging were performed. Results Twenty-one of all 65 patients (32 %) and 17 of 30 patients 60 years or younger (57%), respectively, were still alive at median follow-up of 100 months (range, 77,149 months). Nineteen of 21 patients completed all investigations; 1 was lost to follow-up. In three patients, an exclusively extraneural relapse of a high-grade non-Hodgkin's lymphoma was diagnosed after 9, 31, and 40 months, respectively. All of them experienced complete remission to high dose. Neither late neurotoxicity nor compromise of quality of life was found in any of the patients examined. Interpretation Primary polychemotherapy based on high-dose methotrexate (MTX) and cytarabine (Ara-C) is highly efficient in treatment of primary central nervous system lymphoma. About half of patients 60 years or younger can obviously be cured with this regimen without long-term neurotoxic sequelae or quality-of-life compromise. ANN NEUROL 2010;67:182,189 [source] Natalizumab, multiple sclerosis, and primary central nervous system lymphoma: Enigma, wrapped in mystery, enclosed in conundrum,ANNALS OF NEUROLOGY, Issue 3 2009Richard M. Ransohoff MD No abstract is available for this article. [source] Natalizumab and central nervous system lymphoma: No clear association,ANNALS OF NEUROLOGY, Issue 3 2009Carmen Bozic MD No abstract is available for this article. [source] Primary central nervous system lymphoma in a patient treated with natalizumab,ANNALS OF NEUROLOGY, Issue 3 2009Andreas Schweikert MD A 40-year-old man with relapsing-remitting multiple sclerosis (MS) developed primary central nervous system lymphoma (PCNSL) after having received 21 doses of natalizumab monotherapy. PCNSL is a disease of the elderly, with the majority of patients being diagnosed in the 7th to 8th decade of life. Immunodeficiency, iatrogenic immunosuppression, and some autoimmune diseases are known as predisposing conditions, and in these patients PCNSL peaks in the 4th decade. Because there is no increased prevalence of PCNSL in MS, and the patient was otherwise not immunocompromised, an association between natalizumab therapy and PCNSL cannot be ruled out. Ann Neurol 2009;66:403,406 [source] Influence of methotrexate exposure on outcome in patients treated with MBVP chemotherapy for primary central nervous system lymphomaBRITISH JOURNAL OF CLINICAL PHARMACOLOGY, Issue 3 2010Hélène Blasco WHAT IS ALREADY KNOWN ABOUT THIS SUBJECT Although treated using the same high-dose methotrexate (HD-MTX)-based multiagent chemotherapy, patients with primary central nervous system lymphoma (PCNSL) have significant differences in outcome. However, little information has been published about factors influencing outcome in PCNSL. As it is known that the pharmacokinetics of MTX vary considerably between subjects leading to different exposure in patients receiving the same dose, it is important to evaluate its role in response to chemotherapy. WHAT THIS STUDY ADDS This study is the first to evaluate the exposure,response relationship in patients treated with MBVP chemotherapy. We found that patients who were early non-responders to MBVP chemotherapy had poor survival, whatever the salvage regimen. Tumour response at early evaluation was not associated with MTX pharmacokinetics and increasing the dose would probably not improve results. AIMS Although the standard treatment for primary central nervous system lymphoma (PCNSL) consists of three cycles of MBVP (methotrexate, BCNU, VP16, methylprednisolone) and radiotherapy, early failure of treatment may require modification of the treatment. However, our understanding of the outcome in such patients and of the factors involved in early failure of treatment is poor. In addition to known prognostic factors, we evaluated the influence of methotrexate (MTX) exposure on the response to MBVP chemotherapy in patients treated for PCNSL after the first two cycles. METHODS We retrospectively analyzed all patients with PCNSL treated with the MBVP regimen over the previous 10 years. Clinical, personal data and known prognostic factors were studied. The parameters of MTX exposure were estimated using a population pharmacokinetic approach with NONMEM. Objective response (OR), overall survival (OS) and failure-free survival (FFS) were evaluated in all patients. RESULTS Thirty-seven patients were studied. We observed lower FFS and OS (0.49 years) in patients who were not able to receive the planned treatment (group 1, n= 12) than in those who received three cycles (8.04 years) (group 2, n= 25). Known prognostic factors were comparable in both groups, but mean dose of MTX and mean AUC tended to be lower in patients who failed prematurely or showed no response after two cycles. CONCLUSIONS We found that patients who were early non-responders to MBVP chemotherapy had poor survival, without major influence of MTX exposure. It is thus probably unlikely that increasing the dose of MTX would improve outcome. [source] Primary central nervous system lymphoma: The role of consolidation treatment after a complete response to high-dose methotrexate-based chemotherapy,CANCER, Issue 5 2008Meltem Ekenel MD Abstract BACKGROUND. The most effective treatment for a new diagnosis of primary central nervous system lymphoma is high-dose methotrexate (MTX)-based chemotherapy followed by whole-brain radiation therapy (WBRT). However, this combined modality treatment carries an increased risk of delayed neurotoxicity. For patients who achieve a complete response (CR) after induction that uses high-dose MTX-based chemotherapy, it is not clear if consolidation treatment is necessary. Therefore, a retrospective study was conducted to assess the impact of consolidation treatment after a CR to initial induction chemotherapy on disease control and survival. METHODS. The authors retrospectively analyzed 122 patients who achieved a CR after initial MTX-based chemotherapy. The benefit of consolidation WBRT, high-dose cytarabine (HDAC), or both on failure-free (FFS) and overall survival (OS) was assessed. RESULTS. With a median follow-up of 60 months, FFS was longer in patients who received WBRT plus HDAC as consolidation treatment (P = .03 by univariate analysis); there was no difference in OS observed among patients who received no consolidation treatment, HDAC alone, WBRT plus HDAC, or WBRT alone. Age and Karnofsky performance scale (KPS) were the only independent prognostic factors. Patients who received WBRT alone or in combination with HDAC had higher rates of neurotoxicity. CONCLUSIONS. Consolidation treatment with WBRT, HDAC, or both does not appear to improve survival in patients who achieved a CR with induction MTX-based therapy. Age, KPS, and risk of delayed neurotoxicity must be considered in the choice of consolidation regimens. Cancer 2008. © 2008 American Cancer Society. [source] The continuing increase in the incidence of primary central nervous system non-Hodgkin lymphomaCANCER, Issue 7 2002A Surveillance, End Results analysis, Epidemiology Abstract BACKGROUND Primary central nervous system lymphoma (PCNSL) is an extranodal form of non-Hodgkin lymphoma arising in the craniospinal axis. The incidence of PCNSL appears to be increasing. METHODS PCNSL incidence data from 1973,1997 were obtained from the nine Surveillance, Epidemiology and End Results (SEER) registries. To limit the influence of the human immunodeficiency virus on incidence rates, data of never,married males and females and persons of unknown marital status were excluded. As a surrogate for new technology, SEER data were reviewed by dates of diagnosis (surrogate for imaging) and compared with glioma incidence (surrogate for stereotactic neurosurgery and improved diagnostic neuropathology). Age-adjusted incidence rates were estimated and compared for the period prior to computed tomography (CT) (1973,1984) and the magnetic resonance imaging (MRI) period (1985,1997). The estimated annual percent change was calculated based on linear regression analyses using SEER*STAT. RESULTS The incidence of PCNSL appears to be increasing in all SEER registries examined. All age groups demonstrated an increase over time. This increase was observed both in the CT era as well as in the MRI era. PCNSL age-adjusted incidence (0.15 to 0.48, a 3-fold increase) outpaced that of systemic lymphoma (14.1 to 18.5, a 33% increase) for the same registries over the same time periods. The rate of increase has begun to slow since 1985; the estimated annual percent change for PCNSL was three-fold higher during the period 1973,1985 compared with 1986,1997. CONCLUSION The incidence rate of PCNSL continues to rise. The increase is evident in all age groups and in both genders. Data from the current study suggest that improved diagnostic tools, such as CT or MRI, cannot explain this increase. Cancer 2002;95:1504,10. © 2002 American Cancer Society. DOI 10.1002/cncr.10851 [source] 4367: Intravitreal injection of anti-VEGF and diagnosis of primary intraocular-central nervous system lymphomaACTA OPHTHALMOLOGICA, Issue 2010J GAMBRELLE Purpose We report the case of the diagnosis of primary intraocular- central nervous system (CNS) lymphoma in a patient treated by anti-VEGF. Methods An 88-year old female, with a medical history of bilateral ARMD treated by intravitreal injections of ranibizumab for 1 year, was referred to our department for bilateral vitritis diagnosed 10 days after the last anti-VEGF injection. A complete vitritis work-up including aqueous humour analysis, magnetic resonance imaging of the brain and vitreous biopsy enabled us to confirm the diagnosis of primary intraocular-CNS lymphoma. Results To the best of our knowledge, this is the first report of the diagnosis of primary intraocular-CNS lymphoma in a patient treated by anti-VEGF for ARMD. In our opinion, the occurrence of lymphoma in this case was coincidental and not due to the anti-VEGF injections. The differential diagnosis of vitritis in elderly patients is relatively large. Endophthalmitis or uveitis has been described after anti-VEGF injections. In such a situation, there is actually a risk of overlooking a diagnosis of intraocular lymphoma in the mistaken belief that the observed vitritis may be a reaction to administred anti-VEGFs. If no direct time-relationship with the anti-VEGF injections can be found, a classic vitritis work-up should be performed. Anti-VEGF treatment did not impede cytological diagnosis in our patient. Conclusion Although in some none-CNS non-Hodgkin lymphomas (NHL) systemic anti-VEGF therapy is added to chemotherapy schedules, the use of anti-VEGF did not halt the spread of the lesion within the eye in this case. It can, therefore, be presumed that local anti-VEGF therapy has no adjuvant effect in primary intraocular lymphoma. [source] SHP-1 expression in primary central nervous system B-cell lymphomas in immunocompetent patients reflects maturation stage of normal B cell counterpartsPATHOLOGY INTERNATIONAL, Issue 9 2004Yasuo Sugita SHP-1 is an important negative regulator involved in signaling through receptors for cytokine/growth factors, and differential patterns of SHP-1 expression in several types of B-cell lymphomas closely resemble the patterns seen in their normal B cell counterparts. In an effort to elucidate the origin of primary central nervous system lymphomas (PCNSL), the present study assessed 32 cases of PCNSL. Tumors were subclassified according to WHO classification and were evaluated by immunohistochemistry for expression of antigens associated with germinal center (GC) (CD10, Bcl-6) and non-GC stages (SHP-1, CD138). Twenty-nine cases showed diffuse large-cell centroblastic morphology, whereas three cases showed diffuse large-cell immunoblastic morphology. The immunophenotypes of PCNSL were as follows: SHP-1+/Bcl-6,/CD10,/CD138, (12 of 32 cases); SHP-1+/Bcl-6+/CD10,/CD138, (15 of 32 cases); SHP-1+/Bcl-6+/CD10+/CD138, (two of 32 cases); SHP-1+/Bcl-6,/CD10+/CD138, (one of 32 cases); and SHP-1,/Bcl-6,/CD10,/CD138, (two of 32 cases). These results indicate that PCNSL might be distinct lymphomas that originate from a late germinal center to an early postgerminal center. [source] Initial response to glucocorticoidsCANCER, Issue 2 2006A potentially important prognostic factor in patients with primary CNS lymphoma Abstract BACKGROUND Known prognostic variables in patients with primary central nervous system lymphomas (PCNSL) include age, Karnofsky performance status, involvement of deep regions of the brain, intensity of blood,brain barrier disruption, and treatment with radiation and chemotherapy. PCNSL often responds transiently to glucocorticoids administered to control neurologic symptoms before radiation or chemotherapy. This retrospective chart review was designed to estimate the prognostic significance of a clinical or radiologic response to initial glucocorticoid therapy. METHODS By using data from The Johns Hopkins Cancer Registry from January 1980 to June 2001, a total of 76 human immunodeficiency virus (HIV)-negative adults with newly diagnosed PCNSL were identified. Nineteen patients with uninformative medical records were excluded from the study. RESULTS The median survival of the remaining 57 patients was 11.8 months. The median survival for the 48 patients who had clinical response to initial steroid therapy was 17.9 months, and for nonresponders, it was 5.5 months (P = 0.05). The 16 patients with documented radiologic response had a median survival of 117.0 months compared with 5.5 months for nonresponders (P = 0.001). After adjusting for known prognostic factors (age and treatment), significant reduction in risk of death was noted in patients who had either clinical (hazard ratio [HR] = 0.40; 95% confidence interval [CI], 0.16,0.99}) or radiologic response (HR = 0.14; 95% CI, 0.04,0.46) to glucocorticoids given before radiation or chemotherapy. CONCLUSION This analysis suggests that initial response to treatment with glucocorticoids may be an important prognostic factor in patients with PCNSL. Cancer 2006. © 2005 American Cancer Society. [source] Immunochemotherapy with rituximab and temozolomide for central nervous system lymphomasCANCER, Issue 12 2004Vincenzo Pitini M.D. No abstract is available for this article. [source] | ||||||||||