Dr. Bierman Discusses CNS Involvement in Aggressive NHL

Philip Bierman, MD
Published: Thursday, Aug 02, 2018



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.
SELECTED
LANGUAGE


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.

View Conference Coverage
Online CME Activities
TitleExpiration DateCME Credits
Cancer Summaries and Commentaries™: Update from Atlanta: Advances in the Treatment of Chronic Lymphocytic LeukemiaFeb 28, 20190.5
Community Practice Connections™: 2nd Annual International Congress on Immunotherapies in Cancer™: Focus on Practice-Changing ApplicationFeb 28, 20192.0
Publication Bottom Border
Border Publication
x