Meningeosis lymphomatosa

Background

Lymphomatous meningitis is generally fatal. Specific diagnostic tools are required to optimize therapeutic decisions and to improve patient prognosis. Discriminating between secondary and primary central nervous system (CNS) involvement of lymphoma is important due to differing prognosis and therapeutic consequences.

Objectives

Incidence, diagnostic tools and therapeutic options for lymphomatous meningitis are presented.

Materials and methods

Review of the scientific literature regarding incidence, diagnostic tools and therapeutic options of lymphomatous meningitis.

Results

In addition to lymphomas with known particularly higher risk of CNS involvement, lymphomatous meningitis occurs in DLBCL (diffuse large B-cell lymphoma). Recent investigations revealed ECOG (Eastern Cooperative Oncology Group), IPI (International Prognostic Index), > 1 extranodal involvement, LDH (lactate dehydrogenase), and renal involvement as risk factors for CNS involvement. Specific diagnostic workup of cerebrospinal fluid with conventional cytology, flow cytometry, and magnetic resonance imaging improves the possibility of early diagnosis. Recent protocols including autologous stem cell transplantation are promising, providing curative options.

Conclusions

Flow cytometry offers obvious improvement in detecting lymphoma cells in cerebrospinal fluid. The value of detected lymphoma cells in asymptomatic patients is still unclear and the optimal CNS prophylaxis in DLBCL firstline therapy for reducing central nervous relapse is unknown. Nevertheless recent publications are offering promising data even in curing lymphomatous meningitis.