CNS manifestations in non-Hodgkin lymphomas (NHL)

In a group of 241 patients with non-Hodgkin lymphoma investigated retrospectively, CNS manifestations occurred in 8%, mainly as meningeosis lymphoblastomatosa. Lymphoblastic and immunoblastic NHL showed the highest risk of CNS infiltration (40.7% and 12.5% respectively). Further risk factors were disseminated stage of the disease, prior involvement of the bone marrow and juvenile age. Characteristic symptoms were eye muscle paresis, paresthesias and pareses of peripheral muscles. The most fruitful diagnostic measure was lumbar puncture. More than 80% of the patients observed with CNS manifestations died within one year. The factor limiting life was less the CNS infiltration itself than the systemic progression. CNS prophylaxis should be incorporated in the treatment plan in patients with lymphoblastic and immunoblastic non-Hodgkin lymphoma at an early stage. In contrast CNS prophylaxis is not justified in uncontrollable systemic non-Hodgkin lymphoma spread.