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Cerebrospinal fluid involvement in mantle cell lymphoma
Riccardo Valdez1, Steven H Kroft, Charles W Ross
1Department of Pathology, University of Michigan, Ann Arbor, Michigan 48109-0602, USA. rcdovldz@umich.edu
Summary
Mantle cell lymphoma (MCL) can spread to the central nervous system (CNS). This study found that 9% of MCL patients had CNS involvement, highlighting the need for cerebrospinal fluid (CSF) analysis.
Area of Science:
- Hematology
- Oncology
- Neurology
Background:
- Mantle cell lymphoma (MCL) is an aggressive B-cell neoplasm with poor prognosis.
- MCL frequently presents at advanced stages and disseminates to extranodal sites, including the central nervous system (CNS).
- Cerebrospinal fluid (CSF) analysis is not routinely performed at diagnosis, despite potential CNS involvement.
Purpose of the Study:
- To determine the rate of CSF sampling and identify the frequency of MCL involvement in the CNS.
- To investigate clinical and cytologic features associated with CSF involvement in MCL patients.
Main Methods:
- Retrospective review of 108 MCL patients' medical records across three centers over five years.
- Analysis of CSF cytology, morphology, and flow cytometry results for lymphomatous infiltrates.
- Correlation of CSF findings with clinical presentation and radiographic abnormalities.
Main Results:
- CSF sampling was performed in 23% of patients, primarily due to CNS signs/symptoms.
- MCL involvement in CSF was detected in 40% of sampled patients (10/25), with an overall cohort rate of 9%.
- Morphology and flow cytometry identified CSF involvement, including in blastoid variants; cytology was pleomorphic in most cases.
Conclusions:
- A significant proportion of MCL patients may have CNS involvement, even without overt neurological symptoms.
- Routine CSF analysis should be considered for MCL staging and management to detect sanctuary site involvement.
- Early detection of CNS involvement can potentially improve therapeutic strategies and patient outcomes.