High-dose intravenous methotrexate followed by autologous stem cell transplantation as a potentially effective therapy for neurolymphomatosis

BACKGROUND. Neurolymphomatosis (NL) is a rare neurologic manifestation of systemic lymphoma characterized by lymphomatous infiltration of the peripheral nervous system. The diagnosis of NL is difficult and requires a multidisciplinary approach for obtaining an adequate biopsy specimen of the suspected nerve. The prognosis of patients with NL has been poor because adequate penetration of chemotherapy into the nervous system is difficult. METHODS. The authors presented the case of a 37-year-old man who was treated for Ann Arbor Stage IVB diffuse large B-cell lymphoma. The patient developed disease recurrence in the sciatic nerve without systemic involvement. RESULTS. The patient achieved a clinical response after receipt of high-dose intravenous methotrexate followed by high-dose chemotherapy and autologous stem cell transplant. CONCLUSIONS. The authors reported this case to highlight the effectiveness of this regimen in a rare and fatal disorder. In the current study they also reviewed the literature regarding the diagnosis, prognosis, and treatment of NL.