Primary central nervous system non-Hodgkin's lymphoma (PCNSL): does age and histology at presentation affect outcome?

Primary Non-Hodgkin's lymphoma of the central nervous system (PCNSL) was diagnosed by computer-assisted stereotactic biopsy in 27 non-AIDS patients (22 men, 5 women; mean age, 50.6 years, median age 53 years). Among the various histologies, fourteen patients had diffuse large cell lymphoma (DLC), five had diffuse, small, non-cleaved lymphoma (DSNC) and five had diffuse mixed cell lymphoma (DMC). Immunohistochemical analysis revealed 6 B-cell and 3 T-cell types. Multiple lesions occurred in 11 patients. Most patients received radiation therapy and some received adjunctive and/or salvage chemotherapy. Several factors correlated with survival, median survival for the entire group was 356 days (0.975 years). However, Median survival was 1982 days (5.43 years) for the 8 patients who were less than 45 years old at diagnosis versus 283 days (0.77 years) for the 18 patients who were older (p = 0.03). One patient was lost for follow up. Four of the 5 patients who have survived for more than four years were less than 45 years of age; of these 2 had T-cell lymphoma. Only 3 of the 11 patients with multiple lesions died within the first year. A proportional hazards model was derived for the group and suggested that older age and uncleaved histology are associated with shorter survival. Treatment protocols should include stratification factors to allow comparison between groups with different characteristics and to account for age and/or histology dependent on differences in response.