Primary CNS lymphoma and neurologic complications of hematologic malignancies

This article provides a practical clinical approach to diagnose primary CNS lymphoma and recognize neurologic complications of lymphomas and leukemias. This includes current diagnostic and treatment recommendations for primary CNS lymphoma and complications related to hematologic malignancies.

Primary CNS lymphoma is an uncommon, aggressive non-Hodgkin lymphoma confined to the CNS in the absence of systemic disease. Diagnosis can be made by brain biopsy, CSF analysis, or vitreous fluid analysis. Primary CNS lymphoma is typically diffuse large B cell in histology. Evaluation of extent of disease should be performed before initiation of therapy. Initial induction treatment includes high-dose methotrexate-based chemotherapy. Several studies have demonstrated improved outcome using consolidative whole-brain radiation therapy or high-dose chemotherapy and autologous stem cell transplantation. Neurologic complications can result from direct or indirect effects of leukemia and lymphoma or may be treatment-induced.

Early diagnosis and treatment of patients with primary CNS lymphoma is critical to maintaining neurologic and cognitive function and preserving quality of life. It is important to recognize neurologic complications from leukemia and lymphoma to avoid delays in instituting appropriate treatment.