Absence of meaningful neurocognitive recovery in comatose patients with primary central nervous system lymphoma despite an effective response to chemotherapy: Case reports

Lim,Ryan Mao Heng; Chan,Jason Yongsheng

doi:10.3892/mco.2021.2206

Absence of meaningful neurocognitive recovery in comatose patients with primary central nervous system lymphoma despite an effective response to chemotherapy: Case reports

Authors:
- Ryan Mao Heng Lim
- Jason Yongsheng Chan
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Affiliations: Yong Loo Lin School of Medicine, National University of Singapore, Singapore 117597, Republic of Singapore, Division of Medical Oncology, National Cancer Centre Singapore, Singapore 169610, Republic of Singapore
Published online on: January 13, 2021 https://doi.org/10.3892/mco.2021.2206
Article Number: 44
Copyright: © Lim et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

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Abstract

Primary central nervous system lymphoma (PCNSL) is a rare type of non‑Hodgkin's lymphoma that occurs in patients who are elderly and immunocompromised. The most common treatment for PCNSL is high‑dose methotrexate‑based chemotherapy. Studies have suggested that the radiological response to high‑dose methotrexate‑based chemotherapy is associated with improved neurocognitive ability that remains stable upon follow‑up. However, no study involving patients with an extremely poor neurological status before chemotherapy initiation has been reported, and the neurological prognosis of this group of patients remains unknown. The current case study described 3 patients with PCNSL diagnosed via biopsy who had comatose neurological states due to disease progression prior to treatment. All patients were treated with high‑dose methotrexate‑based chemotherapy. However, although effective radiological responses to treatment were achieved, no meaningful neurological or cognitive recovery was documented. Patients with PCNSL exhibiting a baseline comatose state have a poor neurological prognosis even with an effective tumour response to chemotherapy. Therefore, rapid detection and prompt treatment are crucial in patients with this disease.

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