Involvement of the central nervous system in relapsed T-cell lymphoma: insights from four case studies

CNS involvement in T-cell lymphoma is rare, with a 2–6 % risk of relapse. This report presents four cases of CNS relapse in aggressive T-cell lymphomas, including PTCL NOS, AITL, ALCL ALK (-), and ENKTCL. Patients experienced severe neurological symptoms, elevated CSF WBC counts, and resistance to various treatment regimens, including intrathecal HD MTX, salvage chemotherapy, and immunotherapy. Median survival was 1.5–3.5 months, highlighting the poor prognosis. The findings highlight the complexities of managing CNS relapse, the evolving understanding of prophylactic strategies, and the potential for innovative, targeted therapeutic combinations to enhance outcomes for these high-risk patients.