Prognostic factors in 140 adult patients with non-Hodgkin's lymphoma with systemic central nervous system (CNS) involvement. A single centre analysis

We examined retrospectively the outcome of patients with non-Hodgkin's lymp homa (NHL) with 5-systemic involvement of the central nervous system (CNS) registered at The Norwegian Radium Hospital (NRH) from 1980 to 1996, in ord er to evaluate our treatment strategy for these patients. 170 of 2561 patie nts (6.6%) had CNS involvement, 140 (5.5%) systemic CNS lymphoma (SCNSL) an d 30 (1.2%) primary CNS lymphoma (PCNSL). Description of the patients, time of SCNSL diagnosis, symptoms at CNS diagnosis, treatment and survival were registered. The overall median survival for the 140 patients with SCNSL wa s 2.6 months (95% confidence interval (CI) 2.1-3.2), only 12 patients are a live in complete remission (CR). Patients with CNS involvement at diagnosis , relapse or progression during treatment for NHL had a median survival of 5.4 months (95% CI: 0.3-10.6), 3.8 months (95% CI: 0.0-9.1). and 1.8 months (95% CI: 1.0-2.7), respectively (P = 0.001). 5 of the 8 patients consolida ted with high-dose therapy (HDT) are in CR. Paresis was the only symptom th at predicted survival far SCNSL. Patients above 60 years of age with CNS in volvement at progression or relapse and those with paresis at the time of C NS diagnosis have a dismal prognosis. For these patients supportive therapy only should be considered. For patients under 60 years of age with chemose nsitive disease, the trend was toward better prospects, and they should be offered intensive chemo-radiotherapy including HDT with autologous stem cel l support. (C) 2000 Elsevier Science Ltd. All rights reserved.