Predictive factors for central nervous system involvement in non-Hodgkin'slymphoma: Significance of very high serum LDH concentrations

Factors predictive for central nervous system (CNS) involvement at presenta tion were investigated in 152 patients with non-Hodgkin's lymphoma (NHL) ex cept for lymphoblastic cell lymphoma and small noncleaved cell lymphoma. Tw elve patients developed CNS involvement during their disease course. The in cidence was 7.9% of all the patients studied and 17.0% of the patients with serum LDH concentration greater than or equal to two times the upper limit of normal (2N). By univariate analysis, stage IV disease (P = .023), a ser um LDH concentration greater than or equal to 2 N (P = .009), and bone marr ow involvement (P = .016) were risk factors for CNS involvement. Multivaria te logistic regression analysis identified a serum LDH concentration greate r than or equal to 2 N (P =.032) as an independent predictor for CNS involv ement. All 12 patients who developed CNS involvement were among the 126 pat ients with diffuse lymphoma, whereas none of the 17 patients with follicula r lymphoma developed CNS involvement, although the difference was not stati stically significant. The median survival of the patients with CNS involvem ent was only 4.5 months. We conclude that a serum LDH concentration greater than or equal to 2N at presentation is a significant predictive factor for CNS involvement for NHL patients without lymphoblastic lymphoma and small noncleaved cell lymphoma. Therefore, we would suggest that CNS prophylaxis should be considered for patients with a serum LDH concentration greater th an or equal to 2N at presentation and diffuse lymphoma once a complete remi ssion is achieved.