진단 당시 중추신경계 침범이 있는 소아 비호지킨림프종의 치료 경험

Abstract

Purpose: Lymphoma is the third most common cancer among children and non-Hodgkin lymphoma accounts for approximately 90% of all lymphomas in children and adolescents in Korea. Central nervous system involvement at diagnosis is uncommon and treatment is not standardized. Methods: We retrospectively reviewed the disease characteristics and clinical course in eight patients (six males, two females) having childhood non-Hodgkin lymphoma with central nervous system involvement at initial diagnosis. Results: There were three patients with disseminated central nervous system involvement of non-Hodgkin lymphoma. Five patients were diagnosed with primary central nervous system lymphoma. Two patients had no neurologic symptoms. One patient was false negative for cerebrospinal fluid study but positive by imaging study. Another patient was false negative by computerized tomography but positive for cerebrospinal fluid study. Three among four patients treated with high dose methotrexate were alive. Three patients treated with cranial radiotherapy were alive among four patients with primary central nervous system lymphoma. Conclusion: A subset of patients is asymptomatic and central nervous system involvement may be discovered during the assessment of the disease extent. Considering false negative result of studies, imaging studies and cerebrospinal fluid examination should be simultaneously carried out to confirm the central nervous system involvement. High dose methotrexate treatment was active against central nervous system involvement of non-Hodgkin lymphoma and high dose methotrexate and cranial radiotherapy were active against primary central nervous system lymphoma.