Advances and challenges in the treatment of primary central nervous system lymphoma
- 30 November 2020
- journal article
- review article
- Published by Wiley in Journal of Cellular Physiology
- Vol. 235 (12), 9143-9165
- https://doi.org/10.1002/jcp.29790
Abstract
Primary central nervous system lymphoma (PCNSL), a rare variant of non-Hodgkin's lymphoma, is characterized by distinct biological characteristics and clinical behaviors, and patient prognosis is not satisfactory. The advent of high-dose (HD) methotrexate (HD-MTX) therapy has significantly improved PCNSL prognosis. Currently, HD-MTX-based chemotherapy regimens are recognized as first-line treatment. PCNSL is sensitive to radiotherapy, and whole-brain radiotherapy (WBRT) can consolidate response to chemotherapy; however, WBRT-associated delayed neurotoxicity leads to neurocognitive impairment, especially in elderly patients. Other effective approaches include rituximab, temozolomide, and autologous stem-cell transplantation (ASCT). In addition, new drugs against PCNSL such as those targeting the B-cell receptor signaling pathway, are undergoing clinical trials. However, optimal therapeutic approaches in PCNSL remain undefined. This review provides an overview of advances in surgical approaches, induction chemotherapy, radiotherapy, ASCT, salvage treatments, and novel therapeutic approaches in immunocompetent patients with PCNSL in the past 5 years. Additionally, therapeutic progress in elderly patients and in those with relapsed/refractory PCNSL is also summarized based on the outcomes of recent clinical studies.This publication has 138 references indexed in Scilit:
- Diagnosis and treatment of primary CNS lymphomaNature Reviews Neurology, 2013
- Prognosis of patients with primary central nervous system lymphoma after high-dose chemotherapy followed by autologous stem cell transplantationHaematologica, 2013
- Age, gender, and racial differences in incidence and survival in primary CNS lymphomaBritish Journal of Cancer, 2011
- Methotrexate area under the curve is an important outcome predictor in patients with primary CNS lymphoma: A pharmacokinetic–pharmacodynamic analysis from the IELSG no. 20 trialBritish Journal of Cancer, 2010
- Long-term follow-up of an age-adapted C5R protocol followed by radiotherapy in 99 newly diagnosed primary CNS lymphomas: a prospective multicentric phase II study of the Groupe d’Etude des Lymphomes de l’Adulte (GELA)Annals of Oncology, 2009
- High-dose methotrexate for elderly patients with primary CNS lymphomaNeuro-Oncology, 2009
- Surgical removal of primary central nervous system lymphomas (PCNSL) presenting as space occupying lesions: a series of 33 casesEuropean Journal of Surgical Oncology, 2005
- Is whole‐brain irradiation necessary for primary central nervous system lymphoma?Cancer, 2002
- Autologous Bone Marrow Transplantation as Compared with Salvage Chemotherapy in Relapses of Chemotherapy-Sensitive Non-Hodgkin's LymphomaThe New England Journal of Medicine, 1995
- Primary Malignant Lymphoma of the Brain: A report of 24 cases from the Norwegian Radium HospitalActa Oncologica, 1992