Lymphomatous meningitis

Malignant meningitis is a rare but devastating complication of neoplastic disease. It occurs most commonly in lung, melanoma, breast, primary brain tumours and haematological disorders. It is almost always a diffuse process even when it appears to be limited. The outcome is almost always fatal. Lymphomatous meningitis is generally accepted to occur in about 5% of diffuse large B-cell lymphomas, though rarely at presentation, it is more usual at relapse. The incidence is much higher in Burkitt’s, HIV associated lymphoma, HTLV-1 associated lymphoma, PTLDs and lymphoblastic lymphoma. There is disagreement as to those patients at risk of developing lymphomatous meningitis who may merit prophylaxis. There is a view that all lymphoma patients with a high IPI score are at risk, whilst others have attempted to identify involvement of specific extra-nodal sites such as bone marrow, breast, testicular or the gastro-intestinal tract. It is generally agreed that patients with widespread disease and high serum lactate dehydrogenase levels are at greatest risk.