scholarly journals Radiotherapy in Patients with Mycosis Fungoides and Central Nervous System Involvement

2018 ◽  
Vol 11 (3) ◽  
pp. 721-728
Author(s):  
Garrett L. Jensen ◽  
Bouthaina S. Dabaja ◽  
Chelsea C. Pinnix ◽  
Jillian R. Gunther ◽  
Auris Huen ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Mycosis Fungoides ◽  
Poor Prognosis ◽  
Central Nervous System Involvement ◽  
Patient Characteristics ◽  
Outcome Data ◽  
Cns Involvement ◽  
Radiographic Findings ◽  
Time To Death

Background: Involvement of the central nervous system (CNS) by mycosis fungoides (MF) is rare; however, it portends a poor prognosis. While aggressive multimodality therapy may improve outcomes, the role of radiation therapy (RT) is not well defined. Objectives: We sought to explore the efficacy of RT in the management of CNS involvement by MF. Method: We retrospectively identified five patients with MF and CNS involvement who received cranial or craniospinal RT at a single institution. Patient characteristics, disease features, radiographic findings, treatments delivered, and outcome data were extracted from the electronic medical record. Results: All 5 patients had neurologic deficits at RT initiation, and 4 experienced at least a partial improvement. Of 4 patients evaluated by MRI after RT completion, 3 had complete resolution of CNS disease within the irradiated field. At the time of last follow-up, all patients had died of MF. The median time to death was 7.4 months (range 1.0–21 months) from their diagnosis with CNS involvement and 1.2 months (range 0.4–7.1 months) from the end of RT treatment. Conclusions: We observed high rates of radiographic response and palliation of neurological symptoms. Nonetheless, all patients succumbed to their disease shortly after treatment, confirming the poor prognosis of this condition. Our findings suggest that RT may play a valuable palliative role for these patients.

scholarly journals Treatment of secondary central nervous system involvement in systemic aggressive B cell lymphoma using R-MIADD chemotherapy: a single-center study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Yuchen Wu ◽  
Xuefei Sun ◽  
Xueyan Bai ◽  
Jun Qian ◽  
Hong Zhu ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Involvement ◽  
Central Nervous System Lymphoma ◽  
Progression Free Survival ◽  
B Cell Lymphoma ◽  
High Dose ◽  
Cns Involvement ◽  
The Central Nervous System ◽  
Secondary Central Nervous System

Abstract Background Secondary central nervous system lymphoma (SCNSL) is defined as lymphoma involvement within the central nervous system (CNS) that originated elsewhere, or a CNS relapse of systemic lymphoma. Prognosis of SCNSL is poor and the most appropriate treatment is still undetermined. Methods We conducted a retrospective study to assess the feasibility of an R-MIADD (rituximab, high-dose methotrexate, ifosfamide, cytarabine, liposomal formulation of doxorubicin, and dexamethasone) regimen for SCNSL patients. Results Nineteen patients with newly diagnosed CNS lesions were selected, with a median age of 58 (range 20 to 72) years. Out of 19 patients, 11 (57.9%) achieved complete remission (CR) and 2 (10.5%) achieved partial remission (PR); the overall response rate was 68.4%. The median progression-free survival after CNS involvement was 28.0 months (95% confidence interval 11.0–44.9), and the median overall survival after CNS involvement was 34.5 months. Treatment-related death occurred in one patient (5.3%). Conclusions These single-centered data underscore the feasibility of an R-MIADD regimen as the induction therapy of SCNSL, further investigation is warranted.

scholarly journals Comparison of clinical features of pulmonary cryptococcosis with and without central nervous system involvement in China

2021 ◽  
Vol 49 (2) ◽  
pp. ???
Author(s):  
Xinying Xue ◽  
Xuelei Zang ◽  
Lifeng Wang ◽  
Dongliang Lin ◽  
Tianjiao Jiang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Central Nervous System ◽  
Nervous System ◽  
Clinical Features ◽  
Central Nervous System Involvement ◽  
Pulmonary Cryptococcosis ◽  
Cns Involvement ◽  
Laboratory Findings ◽  
Logistic Regression Models ◽  
Presenting Symptoms

Objective This study aimed to compare the clinical features of pulmonary cryptococcosis (PC) in patients with and without central nervous system (CNS) involvement. Methods We retrospectively reviewed demographics, presenting symptoms, radiographic features, and laboratory findings of patients diagnosed with PC in 28 hospitals from 2010 to 2019. Risk factors for CNS involvement were analyzed using logistic regression models. Result A total of 440 patients were included, and 36 (8.2%) had CNS involvement. Significant differences in fever, headache, and chills occurred between the two groups (overall and with/without CNS involvement) for fever (17.8% [78/440]; 52.8% vs. 14.6% of patients, respectively), headache (4.5% [20/440]; 55.6% vs. 0% of patients, respectively), and chills (4.3% [19/440]; 13.9% vs. 3.5% of patients, respectively). The common imaging manifestation was nodules (66.4%). Multivariate analysis showed that cavitation (adjusted odds ratio [AOR] = 3.552), fever (AOR = 4.182), and headache were risk factors for CNS involvement. Routine blood tests showed no differences between the groups, whereas in cerebrospinal fluid the white blood cell count increased significantly and glucose decreased significantly. Conclusion In patients with PC, the risk of CNS involvement increases in patients with headache, fever, and cavitation; these unique clinical features may be helpful in the diagnosis.

scholarly journals Central nervous system involvement in Chagas' disease: an updating

1993 ◽  
Vol 35 (2) ◽  
pp. 111-116 ◽  
Author(s):  
José Eymard Homem Pittella
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Chagas Disease ◽  
Acute Phase ◽  
Central Nervous System Involvement ◽  
Cns Infection ◽  
Cns Involvement ◽  
Anatomical Basis ◽  
Immunosuppressed Patients ◽  
Acute Form

A review was made of the available literature on central nervous system (CNS) involvement in Chagas' disease. Thirty-one works concerning the acute nervous form and 17 others dealing with the chronic nervous form, all presenting neuropathologic studies, were critically analysed. Based on this analysis, an attempt was made to establish the possible natural history of CNS involvement in Chagas' disease. Among others, the following facts stand out: 1) the initial, acute phase of Trypanosoma cruzi infection is usually asymptomatic and subclinical; 2) only a small percentage of cases develop encephalitis in the acute phase of Chagas' disease; 3) the symptomatic acute forms accompanied by chagasic encephalitis are grave, with death ensuing in virtually all cases as a result of the brain lesions per se or of acute chagasic myocarditis, this being usually intense and always present; 4) individuals with the asymptomatic acute form and with the mild symptomatic acute form probably have no CNS infection or, in some cases, they may have discrete encephalitis in sparse foci. In the latter case, regression of the lesions may be total, or residual inflammatory nodules of relative insignificance may persist. Thus, no anatomical basis exists that might characterize the existence of a chronic nervous form of Chagas' disease; 5) reactivation of the CNS infection in the chronic form of Chagas' disease is uncommon and occurs only in immunosuppressed patients.

Index Case of Cutaneous Follicular Mycosis Fungoides With Central Nervous System Involvement and Review of Literature

2018 ◽  
Vol 40 (3) ◽  
pp. 185-190 ◽  
Author(s):  
Giang Huong Nguyen ◽  
Alexander Mohler ◽  
Michelle Leppert ◽  
Cindy Parra ◽  
Yue-Ping Zeng ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Mycosis Fungoides ◽  
Index Case ◽  
Central Nervous System Involvement ◽  
Review Of Literature ◽  
System Involvement

Central Nervous System Involvement in Adult Acute Lymphoblastic Leukemia (ALL) at Diagnosis and/or at First Relapse: Results from the GET-LALA Group.

Blood ◽  
2007 ◽  
Vol 110 (11) ◽  
pp. 4326-4326
Author(s):  
Oumedaly Reman ◽  
Arnaud Pigneux ◽  
Francoise Huguet ◽  
Norbert Vey ◽  
Andre Delannoy ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Lymphoblastic Leukemia ◽  
Central Nervous System Involvement ◽  
Unrelated Donor ◽  
Cns Involvement ◽  
Cns Disease ◽  
Cns Relapse ◽  
First Relapse ◽  
B Lineage

Abstract Outcome of adult ALL with central nervous system (CNS) involvement is not clearly defined. We studied 104 patients presenting with CNS involvement at diagnosis among 1493 patients (7%) included into the LALA-87 or LALA-94 trials, and 109 patients (9% of first remitters) presenting CNS disease at the time of first relapse among the 709 relapsing patients (15%) included initially in these trials. Treatment of patients presenting CNS involvement at diagnosis consisted in initial chemotherapy completed by 18 double or triple intrathecal injections associated with 15 to 20 Gy cranial irradiation, followed when possible by intensification by allogeneic or autologous stem cell transplantation (SCT). At diagnosis, 43 patients (41%) presenting with CNS involvement had T-lineage ALL, 53 (51%) had B-lineage ALL (of whom 9 were diagnosed as Philadelphia (Ph) chromosome positive ALL), 8 had undifferentiated ALL or unknown immunophenotype. Eighty-seven of 104 (84%) patients with CNS involvement at diagnosis achieved complete remission (CR). Fifty-three patients underwent SCT (25 allogeneic SCT from matched related or unrelated donor, 28 autologous SCT). Overall survival at 7 years was 34% in those with CNS involvement at diagnosis versus 29% (p = NS) for those without. DFS at 7 years was 35% versus 28% (p = NS). There were no significant differences between patients with CNS involvement and those without CNS involvement regarding T lineage ALL, B lineage ALL (including or not Ph ALL). There were also no significant differences regarding patients who underwent transplantation as consolidation intensification, while in patients receiving only chemotherapy patients without initial CNS involvement had a better outcome (p = 0.01). Among the 709 patients with primary relapse, 66 patients (61%) presented a CNS relapse combined with bone marrow relapse, whereas 17 relapses (15%) and 26 relapses (24%) were CNS relapses combined with another extramedullary relapse or isolated CNS relapses respectively. Median time to relapse was 6.7 months (range, 1–62) in patients with CNS relapse versus 11.2 months (1.7–111) in relapsing patients without CNS involvement. Eleven patients (10%) with CNS relapse had CNS involvement at diagnosis, while 98 patients were diagnosed with CNS disease only at the time of first relapse. Overall, 38 out of 109 patients with CNS relapse (35%) achieved CR. The median OS was 6.3 months. Outcome was similar in terms of CR proportion and OS in relapsing patients without CNS involvement. The 2-year OS rates did not show any difference among patients with CNS relapse who had CNS involvement at diagnosis and those with CNS disease only diagnosed at the time of first relapse.Overall, CNS leukemia in adult ALL is uncommon at diagnosis. Patients have a similar outcome than those who did not present with CNS involvement. However, patients benefit from intensification therapy by autologous or allogeneic SCT. CNS leukemia at first relapse are also uncommon but probably underestimated. Outcome is particularly poor as this of all adult ALL in first relapse.

Treatment Of Non-Hodgkin’s Lymphoma With Secondary Central Nervous System Involvement: Encouraging Response Rates Using CNS-Penetrating Idaram Chemotherapy

Blood ◽  
2013 ◽  
Vol 122 (21) ◽  
pp. 4367-4367
Author(s):  
Paul M Maciocia ◽  
Mohsin Badat ◽  
Simon Cheesman ◽  
Jonathan Lambert ◽  
Martin Pule ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Stem Cell ◽  
Poor Prognosis ◽  
Intrathecal Injection ◽  
Response Rates ◽  
Refractory Disease ◽  
Cns Involvement ◽  
Grade 3 ◽  
New Diagnosis

Abstract Introduction Non-Hodgkin’s lymphomas with secondary involvement of the central nervous system (CNS) typically carry a poor prognosis. There is limited data in the literature regarding the optimal therapy for these patients. IDARAM is a cytotoxic regimen which penetrates the CNS. It has demonstrated efficacy in early studies in secondary CNS lymphoma [Moreton et al, Cancer Chemother Pharmacol (2004) 53: 324–8]. We present here the largest series of patients with secondary CNS involvement treated with IDARAM+/- rituximab at University College Hospital London between June 2005 and January 2013. Methods Thirty-eight patients were treated with 1-4 cycles of IDARAM, consisting of methotrexate 12.5mg by intrathecal injection day 1; idarubicin daily 10mg/m2 IV days 1 and 2; dexamethasone 100mg daily IV infusions of 12h duration days 1-3; cytosine arabinoside daily 1000mg/m2 IV over 1 hour days 1 and 2; and methotrexate 2000mg/m2 IV over 2 hours day 3. CSF was analysed for lymphomatous involvement by flow cytometry on D1. Patients with a clear CSF from the outset only received one intrathecal injection on day 1 of cycle 1. Most patients with B-cell lymphoma additionally received 1-2 doses of rituximab 375 mg/m2 IV on day 1 (+/- day 8) of each cycle. Results Baseline characteristics are presented in table 1. 16/38 (42%) patients had secondary CNS involvement at the time of initial diagnosis of NHL or within 2 months (‘New Diagnosis’). 22/38 (58%) had refractory (CNS involvement diagnosed in latter part of therapy or within 3 months of completion of primary therapy) or relapsed (CNS involvement diagnosed at relapse - either combined with a systemic relapse or isolated to CNS) disease. 84 cycles of IDARAM were delivered to 38 patients. Patients received a median of 2 cycles. 20/37 responded (overall response rate (ORR) = 54%) with 12/37 (32%) achieving a complete response and 8/37 (22%) a partial response (PR). Median progression-free survival (PFS) was 6.8 months and overall survival (OS) was 27.5 months. In patients with a ‘New’ diagnosis ORR was 10/15 (67%) CR 7/15 (47%), PR 3/15 (20%), median PFS was 48 months, median OS has not been reached (see figure 1). Neither age nor performance score predicted outcome in these patients. Grade 3 or 4 haematological toxicity was observed in 100% of cycles. Non-haematological grade 3 or 4 toxicities included infection 81%, stomatitis 11.3%, diarrhoea 4.3%, other 6.5%. 4/84 (5%) of cycles were complicated by ITU stay and treatment-related mortality was 2/38 (5%). 8 (21%) of patients received consolidation radiotherapy (4 patients in CR, 4 in PR), 4 patients (10%) received salvage radiotherapy for disease refractory to IDARAM, and 3 patients (8%) received palliative radiotherapy. 8 patients (20%) received an autologous stem cell transplant; 6 (75%) as consolidation and 2 (25%) for disease relapsing after IDARAM. Conditioning was with TBI in 6 (75%) and LEAM/ BEAM in 2 (25%). 2 patients received reduced-intensity conditioned allogeneic stem cell transplants from HLA-matched unrelated donors: one for primary refractory disease and one for relapsed disease after autograft in 1st CR. Of 10 newly diagnosed patients achieving CR/PR with IDARAM, 5/5 who received consolidation autograft, and 4/5 who did not, remain alive (median follow-up 30 months). 1 patient in each group has relapsed. Conclusions IDARAM +/- R is a well-tolerated regime with encouraging response rates in patients with poor prognosis lymphoma. The short duration of survival of patients with relapsed or refractory disease indicates the urgent need to identify efficacious new treatments for these patients. Patients in whom CNS involvement is detected early in the disease course fare reasonably well, including older patients and those with a poor performance status. Disclosures: No relevant conflicts of interest to declare.

Mycosis fungoides with central nervous system involvement

2000 ◽  
Vol 39 (11) ◽  
pp. 874-876 ◽  
Author(s):  
Hayriye Saricaoglu ◽  
Sukran Tunali ◽  
Fahir Ozkalemkas ◽  
Ridvan Ali ◽  
Emel Bulbul ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Mycosis Fungoides ◽  
Central Nervous System Involvement ◽  
System Involvement

scholarly journals Central Nervous System Involvement in Henoch-Schonlein Purpura in Children and Adolescents

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Iliyana H. Pacheva ◽  
Ivan S. Ivanov ◽  
Krastina Stefanova ◽  
Elena Chepisheva ◽  
Lyubov Chochkova ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Arterial Hypertension ◽  
Rare Complication ◽  
Central Nervous System Involvement ◽  
Henoch Schonlein Purpura ◽  
Cns Involvement ◽  
Hyperintense Lesion ◽  
Schonlein Purpura ◽  
Henoch Schönlein Purpura

Central nervous system (CNS) involvement in Henoch-Schonlein purpura (HSP) is rare but poses diagnostic difficulties. The aim of the study was to establish the frequency of CNS involvement in HSP, to analyze its clinical characteristics and do a literature review. Medical files of patients with HSP admitted at the Department of Pediatrics, Plovdiv, were studied retrospectively for a five-year period (2009–2013). Diagnosis was based on the American College of Rheumatology criteria. Out of 112 children with HSP 1 case (0.9%) had CNS involvement presenting as Posterior Reversible Encephalopathy Syndrome (PRES), which may be a result of CNS vasculitis or arterial hypertension. It was an 8-year-old girl with atypical HSP which started with abdominal pain requiring surgery. On the third day after the operation a transient macular rash and arterial hypertension appeared, followed by visual disturbances, hemiconvulsive epileptic seizures, postictal hemiparesis, and confusion. Head CT showed occipital hypodense lesions and MRT-T2 hyperintense lesion in the left occipital lobe. The patient experienced a second similar episode after 2 weeks when palpable purpura had also appeared. Neurological symptoms and MRI resolved completely. HSP can be an etiological factor for PRES in childhood. Although PRES is a rare complication of HSP, clinicians must be aware of it and avoid diagnostic and therapeutic delays.

scholarly journals Successful Bosutinib Experience in an Elderly Acute Lymphoblastic Leukemia Patient with Suspected Central Nervous System Involvement Transformed from Chronic Myeloid Leukemia

2015 ◽  
Vol 2015 ◽  
pp. 1-5 ◽  
Author(s):  
Erden Atilla ◽  
Pinar Ataca ◽  
Elif Ozyurek ◽  
Ilhan Erden ◽  
Gunhan Gurman
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Chronic Myeloid Leukemia ◽  
Myeloid Leukemia ◽  
Lymphoblastic Leukemia ◽  
Central Nervous System Involvement ◽  
Limited Data ◽  
Cns Involvement ◽  
Blast Phase ◽  
The Central Nervous System

Managing the blast phase in chronic myeloid leukemia (CML) is challenging because limited data are available for elderly patients. The involvement of the central nervous system (CNS) increases the risk of a poor prognosis. Here, we present an elderly blast phase CML patient with suspected CNS involvement who was successfully treated with bosutinib.

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