Penn I, Porat G
Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558.
Transplantation. 1995 Jan 27;59(2):240-4.
Central nervous system (CNS) involvement occurred in 289 of 1332 patients (22%) with posttransplant non-Hodgkins lymphomas. The average time of appearance was 33 months (range 3 weeks to 248.5 months) posttransplantation. Lesions were confined to the CNS in 159 patients (55%), while 130 (45%) had involvement of other organs. Lesions involved the brain in 254 patients (88%), the brain and spinal cord in 5 (2%), the spinal cord in 2 (1%), unspecified locations in the CNS in 13 (4%), the meninges in 8 (3%), and the cerebrospinal fluid (CSF) in 7 (2%). All patients whose only involvement of the CNS was of the meninges or CSF had lymphomas involving multiple organs. Many tumors (48%) appeared within one year after transplantation. Brain lesions were frequently multicentric in distribution. Ninety-one (31%) of the 289 patients had no treatment and died, 70 (77%) of their malignancies and 21 (23%) from other causes. Of 198 patients who received treatment 124 (63%) died of their malignancies; 40 (20%) died of other causes, including 17 patients who had had complete remissions following treatment; 22 (11%) are currently alive and in complete remission; and 12 (6%) are alive and still undergoing therapy. The treatment of choice is local radiotherapy to the brain, which either alone (18 patients) or in combination with other modalities (14 patients) caused 32 of the 39 (82%) complete remissions. Ten of 30 patients with disease localized to the CNS survived more than 5 years, including 6 who survived more than 10 years. CNS lymphomas should be suspected whenever a transplant patient has neurologic symptoms however minor, and prompt work-up is essential to eliminate other possible causes. The dismal prognosis can be improved only by early diagnosis and prompt therapy.
1332例移植后非霍奇金淋巴瘤患者中，有289例（22%）发生中枢神经系统（CNS）受累。出现的平均时间为移植后33个月（范围3周~248.5个月）。159例患者（55%）的病变局限于中枢神经系统，而130例（45%）有其他器官受累。254例患者（88%）的病变累及脑，5例（2%）累及脑和脊髓，2例（1%）累及脊髓，13例（4%）位于中枢神经系统的未明确部位，8例（3%）累及脑膜，7例（2%）累及脑脊液（CSF）。仅中枢神经系统的脑膜或脑脊液受累的所有患者均有多器官受累的淋巴瘤。许多肿瘤（48%）在移植后1年内出现。脑病变的分布常为多中心性。289例患者中有91例（31%）未接受治疗而死亡，其中70例（77%）死于恶性肿瘤，21例（23%）死于其他原因。在198例接受治疗的患者中，124例（63%）死于恶性肿瘤；40例（20%）死于其他原因，包括17例治疗后完全缓解的患者；22例（11%）目前存活且处于完全缓解状态；12例（6%）存活且仍在接受治疗。首选的治疗方法是脑部局部放疗，单独放疗（18例患者）或与其他方式联合放疗（14例患者）导致39例完全缓解中的32例（82%）。30例中枢神经系统局限性疾病患者中有10例存活超过5年，其中6例存活超过10年。只要移植患者有神经系统症状，无论多么轻微，都应怀疑中枢神经系统淋巴瘤，及时检查对于排除其他可能原因至关重要。只有早期诊断和及时治疗才能改善这种糟糕的预后。
