[Primary central nervous system lymphoma--a report of 32 cases with literature review]

The incidence of primary central nervous system lymphoma (PCNSL) is increasing, and its prognosis is poor. This study was to investigate the clinical features of PCNSL, and evaluate the efficacy of high-dose methotrexate (MTX)-based chemotherapy for immunocompetent Chinese patients with PCNSL.

Clinical data of 32 patients (median age, 50 years) with pathologically confirmed PCNSL were analyzed retrospectively. Before Nov. 2001, CHOP with or without whole brain radiotherapy (WBRT) was employed; after then, high-dose MTX-based chemotherapy with or without WBRT was employed.

Of the 32 PCNSL patients, 25 (78.1%) were more than 45 years old; 24 (75.0%) suffered intracranial hypertension; 25 (78.1%) had single intracranial mass; no positive case of cerebrospinal fluid (CSF) cellular examination was found; 28 (87.5%) were B-cell lymphoma, among which 19 (59.4%) were diffuse large B-cell lymphoma. Median follow-up of the patients was 13.5 months (1-84 months). Kaplan-Meier test showed that the median overall survival time was 26 months, and the 2-year survival rate was 45.7%. The complete response rate of the 18 patients who received high-dose MTX-based chemotherapy plus WBRT was 61.1%, the median survival time was more than 26 months, and the 2-year survival rate was 65.1%. The efficacy of high-dose MTX-based chemotherapy plus WBRT was better than that of CHOP plus WBRT. Log-rank test showed that the survival time of the patients with performance status (PS) of 0-1 or normal serum lactate dehydrogenase (LDH) was longer than those with PS of 2-3 or elevated LDH.

PCNSL often occurs in middle-aged and aged patients, with intracranial hypertension as the main clinical manifestation. B-cell lymphoma is the predominant subtype. High-dose MTX-based chemotherapy plus WBRT is efficient and feasible for PCNSL.