Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :511
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (661 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed1049    
    Printed24    
    Emailed0    
    PDF Downloaded143    
    Comments [Add]    

Recommend this journal

 


 
  Table of Contents  
LETTER TO THE EDITOR
Year : 2014  |  Volume : 51  |  Issue : 4  |  Page : 468-469
 

Isolated central nervous system relapse in a patient with systemic diffuse large B-cell lymphoma: Diagnostic and treatment challenges


1 Department of Radiation Oncology, Regional Cancer Center, JIPMER, Pondicherry, India
2 Department of Medical Oncology, Regional Cancer Center, JIPMER, Pondicherry, India

Date of Web Publication1-Feb-2016

Correspondence Address:
Dr. P Das
Department of Radiation Oncology, Regional Cancer Center, JIPMER, Pondicherry
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.175319

Rights and Permissions



How to cite this article:
Das P, Dubashi B, Joseph D, Jain A. Isolated central nervous system relapse in a patient with systemic diffuse large B-cell lymphoma: Diagnostic and treatment challenges. Indian J Cancer 2014;51:468-9

How to cite this URL:
Das P, Dubashi B, Joseph D, Jain A. Isolated central nervous system relapse in a patient with systemic diffuse large B-cell lymphoma: Diagnostic and treatment challenges. Indian J Cancer [serial online] 2014 [cited 2019 Aug 19];51:468-9. Available from: http://www.indianjcancer.com/text.asp?2014/51/4/468/175319


Sir,

A 59-year-old female with no associated co-morbidities was diagnosed as non-Hodgkin's lymphoma; Diffuse large B cell type, Ann Arbor Stage IIIA. She was treated with four cycles of chemotherapy (R-CHOP) and developed a fall in ejection fraction. Further doses of anthracycline were withheld (R-COP) and she completed six cycles of chemotherapy. Post treatment evaluation with PET scan revealed complete remission. After a disease free interval of six months she developed multiple episodes of seizures. MRI revealed hyper-intense mass lesion of 4 × 3 cm in the left frontal lobe [Figure 1]. She underwent craniotomy and resection of the lesion. Histopathology was consistent with small round cell tumour. Immunohistochemistry revealed LCA, CD20 and CD10 positive and was negative for GFAP, Pan CK and CD3 with Ki-67 80% positive suggestive of diffuse large B-cell lymphoma. Staging work up with PET scan including CSF study was negative. Viral serology for HIV, Hepatitis B and Hepatitis C were negative. A final diagnosis of isolated CNS relapse in a patient with systemic NHL was made. She received four cycles of systemic hyper CVAD protocol of chemotherapy with omission of anthracycline followed by whole brain radiation therapy (WBRT). Tolerance to chemotherapy was good. She developed grade-IV febrile neutropenia requiring antibiotics and growth factors. She is currently in complete remission [Figure 1].
Figure 1: Gadolinium contrast enhanced T1W MRI on coronal view showing enhancing mass lesion in left frontal region with mass effect, compression of left lateral ventricle and minimal midline shift to right side is visualised

Click here to view


Central nervous system (CNS) relapse usually occur during progression or after recurrence of systemic lymphoma. They often present as an expression of end-stage disease refractory to most therapeutic strategies. In contrast, isolated CNS relapse with no evidence of lymphoma outside the CNS at the time of relapse occurs in approximately 1% of patients with systemic non-Hodgkin's lymphoma. Isolated CNS disease as the initial relapse site after a complete response (CR) to systemic treatment may be potentially treatable.[1],[2] The simultaneous development of systemic and CNS disease as seen in most patients has important therapeutic implications. Symptoms and signs of CNS involvement are caused by either leptomeningeal and/or parenchymal involvement and in recent years, since the routine use of MRI, parenchymal involvement is recognized more frequently.[3],[4]

Conventional therapy for overt meningeal lymphoma consists of intrathecal or intraventricular chemotherapy often combined with WBRT. The survival data of patients with leptomeningeal lymphoma is dismal despite the high rate of initial response and ranges between two and six months with a one-year survival of 12-23%.[4] The objective of this report is to demonstrate the rarity of presentation and the role of hyper CVAD protocol chemotherapy with whole brain radiotherapy in the treatment of isolated CNS relapse.

 
  References Top

1.
Doolittle ND, Abrey LE, Shenkier TN, Tali S, Bromberg JE, Edward A, et al. Brain parenchyma involvement as isolated central nervous system relapse of systemic non-Hodgkin lymphoma: An International Primary CNS Lymphoma Collaborative Group report. Blood 2008;111:1085-93.  Back to cited text no. 1
    
2.
Feugier P, Virion JM, Tilly H. Incidence and risk factors for central nervous system occurrence in elderly patients with diffuse large B-cell lymphoma: Influence of rituximab. Ann Oncol 2004;15:129-33.  Back to cited text no. 2
    
3.
Bokstein F, Lossos A, Izidore S, Lossos IS, Siegal T. Central nervous system relapse of systemic non-Hodgkin's lymphoma: Results of treatment based on high-dose methotrexate combination chemotherapy. Leuk Lymphoma 2002;43:587-93.  Back to cited text no. 3
    
4.
van Besien K, Ha CS, Murphy S, McLaughlin P, Rodriguez A, Amin K, et al. Risk factors, treatment, and outcome of central nervous system recurrence in adults with intermediate-grade and immunoblastic lymphoma. Blood 1998;91:1178-84.  Back to cited text no. 4
    


    Figures

  [Figure 1]



 

Top
Print this article  Email this article
 

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow