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Lymphomatous meningitis
Hatton C
Consultant Hematologist, Department of Hematology John Radcliffe
Hospital Headington Oxford, UK
Malignant meningitis is a rare but devastating complication of
neoplastic disease. It occurs most commonly in lung, melanoma,
breast, primary brain tumours and haematological disorders. It is
almost always a diffuse process even when it appears to be limited.
The outcome is almost always fatal.
Lymphomatous meningitis is generally accepted to occur in about 5%
of diffuse large B-cell lymphomas, though rarely at presentation,
it is more usual at relapse. The incidence is much higher in
Burkitt’s, HIV associated lymphoma, HTLV-1 associated
lymphoma, PTLDs and lymphoblastic lymphoma. There is disagreement
as to those patients at risk of developing lymphomatous meningitis
who may merit prophylaxis. There is a view that all lymphoma
patients with a high IPI score are at risk, whilst others
have attempted to identify involvement of specific extra-nodal
sites such as bone marrow, breast, testicular or the
gastro-intestinal tract. It is generally agreed that patients with
widespread disease and high serum lactate dehydrogenase levels are
at greatest risk. [>Read full article in
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