Risk stratification for secondary CNS involvement in non-Hodgkin lymphoma integrating histologic, clinical, and molecular factors
| Histologic subtype . | Histologic subtype-specific risk factors . | Approximate CNS relapse risk . |
|---|---|---|
| DLBCL | CNS-IPI ≥ 46 | 10% at 2 y |
| or involvement of breast,17 testis,18 uterus,19 epidural,20,21 kidney/adrenals6,16 | Varies by site | |
| MYC/BCL2 DE DLBCL, particularly if ABC subtype22 | 10% at 2 y (15% if ABC COO) | |
| CD5+ DLBCL23 | 12.7% at 2 y | |
| Intravascular large B-cell lymphoma24 | 25% at 3 y | |
| IgM-secreting DLBCL25 | 41% cumulative incidence (7 of 17) | |
| HGBL with MYC and BCL2 and/or BCL6 rearrangements26 | 13% at 3 y | |
| MCL | Blastoid histology or Ki-67 ≥ 30%27 | 25.4% at 2 y |
| PTCL (PTCL-NOS, AITL, ALCL) | >1 extranodal site, skin or gastrointestinal involvement28 | ∼10% at 2 y |
| ALK+ ALCL | >1 extranodal site29 | 1-y 15% |
| Histologic subtype . | Histologic subtype-specific risk factors . | Approximate CNS relapse risk . |
|---|---|---|
| DLBCL | CNS-IPI ≥ 46 | 10% at 2 y |
| or involvement of breast,17 testis,18 uterus,19 epidural,20,21 kidney/adrenals6,16 | Varies by site | |
| MYC/BCL2 DE DLBCL, particularly if ABC subtype22 | 10% at 2 y (15% if ABC COO) | |
| CD5+ DLBCL23 | 12.7% at 2 y | |
| Intravascular large B-cell lymphoma24 | 25% at 3 y | |
| IgM-secreting DLBCL25 | 41% cumulative incidence (7 of 17) | |
| HGBL with MYC and BCL2 and/or BCL6 rearrangements26 | 13% at 3 y | |
| MCL | Blastoid histology or Ki-67 ≥ 30%27 | 25.4% at 2 y |
| PTCL (PTCL-NOS, AITL, ALCL) | >1 extranodal site, skin or gastrointestinal involvement28 | ∼10% at 2 y |
| ALK+ ALCL | >1 extranodal site29 | 1-y 15% |
ABC, activated B cell; AITL, angiommunoblastic T-cell lymphoma; ALCL, anaplastic large cell lymphoma; ALK, anaplastic lymphoma kinase; HGBL, high-grade B-cell lymphoma; IgM, immunoglobulin M; MCL, mantle cell lymphoma; PTCL-NOS, peripheral T-cell lymphoma, not otherwise specified.