Dr. Bierman Discusses CNS Involvement in Aggressive NHL

Philip Bierman, MD, professor, Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, discusses central nervous system (CNS) involvement in aggressive subtypes of non-Hodgkin lymphoma (NHL).

Approximately 1% to 2% of cases of large cell lymphoma will have CNS involvement. This is sometimes called concurrent CNS and systemic lymphoma. If a patient with CNS involvement relapses, it is usually in the first few months after starting treatment. This could involve the brain parenchyma or the leptomeningeal compartment. CNS involvement occurs more frequently in NHL that has an aggressive histology such as Burkitt lymphoma.

There are guidelines on how to manage these patients from ASCO, the NCCN, and ESMO. Bierman says that most of these guidelines suggest R-CHOP with mid-cycle methotrexate. Generally, Bierman says that he suggests at least 3 g/m² of high-dose methotrexate, as that is the level required to create micromolar concentrations in the spinal fluid, which are needed to eradicate the lymphoma.