Clinicopathological Features and Predictors of Survival in Primary CNS Lymphoma

Abstract

Background: Primary CNS lymphoma (PCNSL) is a rare form of extranodal lymphoma, representing 3 to 4% of brain tumors. We aim to report the clinicopathological features and predictors of survival in patients with PCNSL.

Materials and Methods: This retrospective study was conducted at Shifa International Hospital, Pakistan. Patients diagnosed with PCNSL from 2018 to 2023 were included. Hans algorithm was used to further categorize cases of high grade lymphoma. Data was analyzed using IBM® SPSS Statistics Software Version 26.

Results: Fifty-two patients were diagnosed with PCNSL during the study period, out of whom twenty-seven patients had complete clinical and laboratory data available. From these 27 patients, 14 (52%) were male. Mean age was 48.78 ± 13.46 years. Twenty-four (88.9%) patients were immunocompetent and none had HIV infection. On radiology, a solitary lesion was seen in 19 (70.4%) patients with parietal lobe being the most common location in 8 patients. 26 patients were diagnosed with High grade Non Hodgkin B-Cell Lymphoma whereas one patient had Low grade Non Hodgkin B-Cell Lymphoma. Seven patients expired, with median survival of 5 months (range 1 – 31 months). Ki-67 proliferative index >80% was the only factor identified as significantly associated with decreased overall survival (p<0.05).

Conclusion: PCNSL is a rare and aggressive disease. High Ki-67 proliferative index is a significant predictor of overall survival in these patients. Lack of association of HIV, frequent occurrence of Bcl6 positivity and a single case of Low-grade lymphoma were unique features identified in our study population.