Central nervous system involvement following diagnosis of XXXX : a risk model.

@entity1 @entity1893 @entity981 @entity880
BACKGROUND: To determine the incidence and risk factors for central nervous system (CNS) relapse in @entity1 with @entity1893 ( @entity1893 ). @entity1 AND METHODS: @entity1 records were registered prospectively in successive @entity1 with @entity1893 admitted to the Norwegian Radium Hospital from 1980 to 1996. A total of 2514 @entity1 had no CNS involvement at diagnosis and were treated according to standard protocols. The incidence and risk factors for CNS progression or relapse were examined retrospectively. RESULTS: In low-grade (L)- @entity1893 , the risk of CNS involvement was low (2.8%). In high-grade (H)- @entity1893 , lymphoblastic and Burkitt's @entity1893 @entity1 had a high risk of CNS recurrence (24.4%) at 5 years, and prophylaxis seemed to reduce this risk. For the other @entity1 with @entity1893 , the proportion with CNS involvement at 5 years was 5.2%. Multivariate analysis identified five independent risk factors, each present in >5% of patients: elevated serum @entity880 dehydrogenase, serum albumin <35 g/l, <60 years of age, retroperitoneal lymph node involvement and involvement of more than one extranodal site. If four or five of these risk factors were present, the risk of CNS recurrence was in excess of 25% at 5 years. CONCLUSIONS: The risk of CNS involvement in this study is comparable with the results from other large series. CNS prophylaxis is not recommended in any subgroup of @entity1893 . The risk of CNS involvement among @entity1 with either Burkitt's or @entity981 is considerable and these @entity1 should therefore receive intensive chemotherapy including systemic and intrathecal methotrexate. @entity1 with other types of @entity1893 should receive adequate CNS prophylaxis if at least four of the five risk factors identified are present.
