Central Nervous System Involvement in Patients with Diffuse Large-B Cell Lymphoma: A Retrospective Analysis of a Single Center in Brazil.

Relapse in the central nervous system (CNS) after initial treatment of diffuse large-B cell lymphoma (DLBCL) is an uncommon but serious complication. This retrospective study of a single institution in a Latin American country investigated the incidence of CNS involvement in patients with DLBCL and compared it with results in developed countries.

A total of 134 patients treated for DLBCL from January 2001 to April 2008 were retrospectively analyzed for incidence of secondary CNS involvement of lymphoma.

Twenty six (19,4 %) patients of this cohort had used rituximab as first line treatment and nine (6,7%) had done IT chemoprophylaxis. Seventy (52%) were stage III and IV. Forty seven (35%) had high intermediate or high international prognostic index. Nine of 134 (6,7%) developed CNS disease after a median observation of 36 months. The median time for the CNS relapse or progression was 7,7 months after diagnostic and all but one patient died despite the treatment proposed. Among the 9 patients that relapsed, seven (77,7 %) had parenquimal CNS involvement. Seven (77,7%) had stage III or IV disease. One (11,1 %) had bone marrow involvement. Two (22,2%) received IT chemoprophylaxis and 3 (33,3%) had used rituximab.

We describe here our cases and emphasize that as we know, this is the only Brazilian study investigating this kind of involvement. Different than expected, we found a similar CNS infiltration compared to developed countries cohorts. This suggests that CNS disease is probably related to biologic features than circumstantial issues normally present in developing countries such as late diagnoses and treatment. The evaluation of the risk factors for CNS involvement had not been done due to the small cohort.

No relevant conflicts of interest to declare.