Lymphoma - brain

Alternative names
Brain lymphoma; Cerebral lymphoma; Primary lymphoma of the central nervous system; Primary lymphoma of the brain

Definition
A brain lymphoma is a type of malignancy (cancer). The term “primary” in this case means the cancer seems to have originated in the brain, not spread from somewhere else in the body.

Causes, incidence, and risk factors

The cause of primary brain lymphoma is unknown, but it is more common in people between the ages of 45 and 70. Patients who are immunocompromised, such those with HIV or organ transplants, especially heart transplants, are at greater risk for primary lymphoma of the brain. In immunocompromised patients, the lymphoma is linked to Epstein Barr Virus (EBV) infection.

The incidence is rising, but primary brain lymphoma is still relatively rare.

Symptoms

     
  • Personality changes  
  • Confusion  
  • Changes in speech  
  • Changes in vision  
  • Weakness in hands  
  • Numbness to hot, cold, and pain  
  • Headaches  
  • Seizures  
  • Hallucinations

Signs and tests
The following tests may be performed to help diagnose a primary lymphoma of the brain:

     
  • Biopsy of the brain - shows lymphoma  
  • Head CT scan - shows a brain lesion  
  • CSF total protein - high  
  • CSF cell count - shows increased white blood cells or lymphoma cells

Treatment

The initial treatment is usually with corticosteroids. However, chemotherapy increases survival in many individuals up to 3-4 years, or longer. The chemotherapy is primarily high-dose methotrexate given intravenously or via the spinal cord.

Treatment of immunocompromised patients is not as successful, but is improving.

Radiation therapy used to be the main treatment for this lymphoma, but now is usually reserved for treating those patients in whom chemotherapy is not successful.

Expectations (prognosis)

The survival of untreated primary brain lymphoma is under 2 months. Treated with chemotherapy, patients often survive 3-4 years or more. About 40% of patients are alive at 5 years. In general, older patients have a worse outlook than younger patients.

Complications
Possible complications include:

     
  • Radiation side effects, including confusion, headaches, neurologic problems, and tissue death  
  • Chemotherapy side effects, including low blood counts  
  • Recurrence of the lymphoma

Johns Hopkins patient information

Last revised: December 4, 2012
by Harutyun Medina, M.D.

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