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[Long term remission following relapsed CNS lymphoma]
1First Department of Internal Medicine, Nihon University School of Medicine, Tokyo.
Summary
This case study highlights successful long-term remission of central nervous system (CNS) relapse in non-Hodgkin lymphoma (NHL). Vigorous treatment involving intrathecal chemotherapy and focal brain irradiation achieved sustained neurological remission.
Area of Science:
- Oncology
- Neurology
- Hematology
Background:
- Non-Hodgkin lymphoma (NHL) can relapse in the central nervous system (CNS), posing a significant treatment challenge.
- Previous treatment included CHOP followed by MACOP-B for diffuse large cell NHL.
Observation:
- A 61-year-old male patient presented with visual disturbances and limb numbness, indicative of CNS relapse.
- Diagnostic workup revealed lymphoma cells in cerebrospinal fluid (CSF), a left frontal lobe tumor on imaging (CT, MRI), and positive Ga scintigraphy.
Findings:
- The patient received 21 whole brain irradiations plus 1.0 Gy focal irradiation to the left frontal lobe.
- Intrathecal administration of cytarabine (Ara-C) was also administered.
- Tumor resolution was observed within eight days, leading to neurological remission.
Implications:
- This case demonstrates the efficacy of combined intrathecal chemotherapy and focal brain irradiation for CNS relapse of NHL.
- Achieving long-term remission in such cases is possible with aggressive therapeutic strategies.
- Highlights the importance of prompt diagnosis and multimodal treatment for CNS involvement in lymphoma.