Management of Burkitt's lymphoma involving the central nervous system

The clinical features and pathogenesis of CNS involvement in Burkitt's lymphoma have been reviewed, with an emphasis on the relevant therapeutic approaches. Certain "prophylactic" measures have been suggested and several are currently undergoing clinical trial. These include the use of CCNU, a nitrosourea which effectively crosses the blood-brain barrier, and the use of craniospinal irradiation early in the course of treatment. Malignant pleocytosis can be palliated by the use of intrathecal chemotherapy, but malignant cells in peripheral nerves or deep in the sulci of the brain parenchyma will be relatively inaccessible to drugs in the circulating cerebrospinal fluid (CSF). A bilateral approach (i.e. simultaneous systemic plus intrathecal chemotherapy) may kill cells lodged in this anatomic sanctuary, and the increased use of cytotoxic drugs crossing the blood-brain barrier may facilitate this approach.