Haematologica 2002; 87:(04)EIM16
[Medline] [prev] [index] [next]Isolated massive meningeal progression in aggressive non-Hodgkin's lymphoma
Massimo Magagnoli, Andrea Nozza, Armando Santoro.
Department of Medical Oncology and Hematology, Istituto Clinico Humanitas, Rozzano, Italy
Correspondence: Massimo Magagnoli, MD, Department of Medical Oncology and Hematology, Istituto Clinico Humanitas- Via Manzoni 56, 20089 Rozzano (Milano)-Italy. Tel: +39-02-8224 4533; fax: +39-02-8224 4590. E-mail: massimo.magagnoli@humanitas.it
We report the case of a 41-year old male diagnosed in April 2001 as having a diffuse large cell lymphoma (DLCL-B) with bulky inguinal involvement (stage III B, IPI 2). After induction therapy (intensified CHOP), he achieved partial remission and in October started cytoreductive chemotherapy with vinorelbine, ifosfamide and high-dose cytarabine (VIHA) as pre-transplant induction regimen. After a second course he was hospitalized because of Cytomegalovirus pneumonia which regressed after specific therapy (Foscarnet).
At the time of discharge he developed progressive mental deterioration. Magnetic resonance imaging studies of the brain did not reveal evidence of leptomeningeal disease or intracranial masses. Lumbar puncture tap was performed for cerebral spinal fluid (CSF) examination. Cytologic and immunophenotypic analysis documented a CSF progression, revealing a massive presence of DLCL-B cells (Figures 1 and 2). Microbiological examination did not document any infecting pathogen in the CSF. The patient was immediately treated with intrathecal methotrexate (15 mg) and prednisolone (20 mg) every two days, till CSF cytological negativization (1-3) . His condition rapidly improved with no more neurological symptoms and CSF cytologic examination was negative after nine intrathecal instillations of chemotherapy. Meantime no clinical or imaging signs of systemic progression were evident. Additional intrathecal and systemic chemotherapy is currently ongoing.References