Central nervous system disease in hematologic malignancies: historical perspective and practical applications

Area of Science:

• Hematology
• Oncology
• Neurology

Background:

• Acute lymphoblastic leukemia (ALL) survival rates are improving, with a focus on enhancing quality of life by reducing cranial irradiation.
• Central nervous system (CNS) involvement in non-Hodgkin lymphoma (NHL) is linked to specific patient factors and carries a poor prognosis, necessitating careful treatment strategies.

Purpose of the Study:

• To review current and past practices of intrathecal therapy for CNS involvement in ALL and NHL.
• To discuss risk models for predicting CNS relapse in NHL.
• To explore novel treatment options for relapsed or refractory CNS leukemia and lymphoma.

Main Methods:

• Review of current and historical treatment protocols for CNS-directed therapy in ALL and NHL.
• Analysis of risk factors associated with CNS involvement and relapse in NHL.
• Evaluation of systemic chemotherapy, intrathecal therapy, and emerging treatment options.

Main Results:

• Contemporary ALL treatment emphasizes systemic chemotherapy and optimized intrathecal therapy to limit cranial irradiation.
• CNS involvement in NHL is associated with poor prognosis, with autologous stem cell transplant offering extended survival in refractory cases.
• CNS prophylaxis is crucial for high-risk NHL subtypes, though its use in diffuse large B-cell lymphoma remains debated.

Conclusions:

• Optimizing intrathecal therapy and systemic chemotherapy are key to improving CNS-directed treatment in ALL and NHL.
• Risk stratification models are essential for guiding CNS prophylaxis decisions in NHL.
• Further research into novel agents like thiotepa and liposomal cytarabine is needed for refractory CNS disease.