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Neuro-Oncology 2000 2(4):229-238; doi:10.1093/neuonc/2.4.229
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© 2000 by the Society forNeuro-Oncology

Posttransplant primary CNS lymphoma

Thanh G. Phan, Brian P. O'Neill2 and Paul J. Kurtin

Department of Neurology (T.G.P., B.P.O.) and the Division of Hematopathology (P.J.K.), Mayo Clinic and MayoFoundation, Rochester, MN 55905

2 Address correspondence and reprint requests to Brian P. O'Neill, Department ofNeurology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905.


  Abstract

The records and neuro-imaging studies of 8 cases of post-transplant primaryCNS lymphoma (PT-PCNSL) diagnosed at Mayo Clinic Rochester between 1970 and1998 were reviewed retrospectively. All patients received organtransplantation. Patients who had hematologic transplantation were notincluded in the analysis. The median and mean age of the 4 men and 4 women was45 years (range, 34 to 50 years). The median duration of symptoms beforediagnosis was 36 days (range, 5 to 98 days). At diagnosis, the neurologicexamination was focally abnormal in 6 of 8 patients. Compared with the initialcomputed tomographic study, MRI showed 25 additional brain lesions. Only 43.7%of lesions enhanced with contrast agent; of those that did, all but one wereheterogeneous. Ependymal contact occurred in 5 patients. MRI lesion burdenincreased proportionally to the interval between scans. Diagnostic tissue wasobtained by stereotactic biopsy from 6 patients and by open biopsy from 2.Hemorrhage occurred in the biopsy area in 4 patients who had stereotacticbiopsy and 2 died (all had normal coagulation studies). Slides available forreview (7 patients) showed that the tumors were of CD20-positive lineage andwere positive for Epstein-Barr virus, using in situ hybridization. Sixpatients died. Median survival for the cohort was 13 weeks. PT-PCNSL hasclinical and imaging features distinct from typical PCNSL. In our series, (1)PT-PCNSL presented nonspecifically and progressed rapidly, (2) stereotacticbrain biopsy had significant morbidity, and (3) despite multimodal therapy,survival was poor.

Received June 5, 2000; Accepted July 17, 2000


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