Lymphomatous Meningitis: Symptoms, Prognosis, and Treatment

Lymphomatous meningitis [LM], also known as leukemic meningitis, is an extremely serious peripheral cancer that attacks the tissue that covers the spinal cord and brain. This tissue, the "meninges," protects the nervous system and when it is compromised by LM, the flow of cerebrospinal fluid [CSF] is compromised, resulting in a rapid deterioration of the central nervous system. It should be noted that "meningitis" is a somewhat inaccurate name as it implies inflammation which is not always present.

Incidence

Fewer than 10% of cancer patients with cancer are diagnosed with LM; because LM is a peripheral cancer, often diagnosed by autopsy, it is difficult to state incidence rates with high accuracy. It is known that LM incidence is on the rise, possibly because improved treatment of primary cancers results in more patients who are vulnerable to this condition which is especially prevalent in recurring cancers.

LM is of particular interest to lymphoma patients as some lymphoma patients carry a higher risk for LM than other cancer patients.

• Approximately 4% of non-Hodgkin’s lymphoma (NHL) patients develop LM
• For lymphoblastic or Burkitt's lymphoma the incidence rate may be as high as 24%
• Leukemia patients are also especially prone to the condition and exhibit an incidence rate of 5-15%

Symptoms

Symptoms are generally the result of the obstructed flow CSF by inflammation and/or tumors. They vary widely and do not always raise a "red flag" for LM. Symptoms may include:

• Pain and seizures (the most common patient-reported symptoms)
• Headaches (usually associated with nausea, vomiting, lightheadedness)
• Gait difficulties from weakness or ataxia
• Memory problems
• Incontinence
• Sensory abnormalities

Prognosis

It is generally believed that LM is underdiagnosed because of widely varying symptoms and the fact that it is preceded by other cancers, often in the later stages. If not detected, it usually results in death within four to six weeks. It is not often cured but it is treatable.

Treatment

Both radiation therapy and chemotherapy are indicated for lymphomatous meningitis; sometimes a combination of the two is employed.

In the case of chemotherapy, cytarabine is the first choice. DepoCyt®, a liposome-encapsulated time-release form of cytarabine, is a favored treatment because it is only administered once every two weeks as opposed to multiple times per week for the non-encapsulated form.

Sources

• Moffitt Cancer Center
• Chamberlain, Marc C., M.D., "Lymphomatous Meningitis in Primary Central Nervous System Lymphoma," American Association of Neurological Surgeons
• Hollender A et al, "Central nervous system involvement following diagnosis of non-Hodgkin’s lymphoma: a risk model," Ann Oncol.
• Van Horn, Alixis, RN, Lymphomatous Meningitis, Clinical Journal of Oncology Nursing

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