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Treatment Options for Recurrent Primary CNS Lymphoma.
- Source :
-
Current treatment options in oncology [Curr Treat Options Oncol] 2022 Nov; Vol. 23 (11), pp. 1548-1565. Date of Electronic Publication: 2022 Oct 07. - Publication Year :
- 2022
-
Abstract
- Opinion Statement: Primary CNS lymphoma (PCNSL) constitutes a rare extranodal variant of non-Hodgkin lymphoma (NHL) with an annual incidence of 0.45/100,000. Given the paucity of large prospective clinical trials, there is no consensus treatment for refractory or relapsed (r/r) PCNSL, and available strategies are largely based on retrospective analyses. Patient age, performance status, previously administered treatment, duration of response, and molecular characteristics guide selection of salvage therapy. Patients with a good performance status (KPS >70), particularly ≤65 years, and adequate organ function should be considered for salvage polychemotherapy. Based on its high overall response rate even in the relapsed setting, we choose high-dose (≥ 3.5g/m <superscript>2</superscript> ) methotrexate (HD-MTX) based regimens, e.g., R-MPV (rituximab, HD-MTX, procarbazine, and vincristine), for remission re-induction as long as patients were sensitive to first line HD-MTX-based regimens, especially when duration of previous response was ≥ 1 year. Following successful remission induction, we choose myeloablative chemotherapy (e.g., thiotepa, busulfan, cyclophosphamide) and subsequent autologous stem cell transplant in curative intent whenever feasible. Alternatively, conventional chemotherapy regimens (for example, monthly HD-MTX) or low-dose whole-brain radiation therapy (WBRT) are selected for consolidation in non-transplant candidates in complete remission. In cases of HD-MTX refractory disease or contraindications, we use pemetrexed; temozolomide/rituximab; high-dose cytarabine; or whole brain radiation for remission induction. Clinical trial participation is considered as well. Emerging therapies for upfront or salvage therapy under ongoing investigation include bruton tyrosine kinase inhibition (e.g., ibrutinib), immunomodulatory drugs (e.g., lenalidomide), immune checkpoint inhibitors (ICI, e.g., nivolumab), and chimeric antigen receptor T (CAR-T) cell therapy.<br /> (© 2022. The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature.)
- Subjects :
- Humans
Thiotepa therapeutic use
Busulfan therapeutic use
Rituximab therapeutic use
Agammaglobulinaemia Tyrosine Kinase
Methotrexate therapeutic use
Vincristine therapeutic use
Retrospective Studies
Lenalidomide therapeutic use
Pemetrexed therapeutic use
Nivolumab therapeutic use
Temozolomide therapeutic use
Immune Checkpoint Inhibitors
Procarbazine therapeutic use
Prospective Studies
Antineoplastic Combined Chemotherapy Protocols therapeutic use
Antineoplastic Combined Chemotherapy Protocols adverse effects
Cranial Irradiation
Cytarabine therapeutic use
Cyclophosphamide therapeutic use
Central Nervous System Neoplasms diagnosis
Central Nervous System Neoplasms etiology
Central Nervous System Neoplasms therapy
Receptors, Chimeric Antigen
Brain Neoplasms etiology
Lymphoma, Non-Hodgkin therapy
Lymphoma, Non-Hodgkin drug therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1534-6277
- Volume :
- 23
- Issue :
- 11
- Database :
- MEDLINE
- Journal :
- Current treatment options in oncology
- Publication Type :
- Academic Journal
- Accession number :
- 36205806
- Full Text :
- https://doi.org/10.1007/s11864-022-01016-5