Diagnosis and management of primary central nervous system lymphoma. Issue 22 (26th September 2017)

• Record Type: Journal Article
• Authors: Han, Catherine H.; Batchelor, Tracy T.
• Is Part Of: Cancer. Volume 123:Issue 22(2017)
• Page Start: 4314
• Page End: 4324
• Publication Date: 2017-09-26
• Subjects: autologous stem cell transplantation -- high‐dose methotrexate -- neurotoxicity -- primary central nervous system (CNS) lymphoma -- whole‐brain radiotherapy; Cancer -- Periodicals; Cancer -- Cytopathology -- Periodicals; 616.99405
• DOI: 10.1002/cncr.30965
• Languages: English
• ISSNs: 0008-543X

Abstract

Abstract : Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal non‐Hodgkin lymphoma (NHL) that is confined to the brain, eyes, spinal cord, or leptomeninges without systemic involvement. The overall prognosis, diagnosis, and management of PCNSL differ from those for other types of NHL. Prompt diagnosis and initiation of treatment are vital for improving clinical outcomes. PCNSL is responsive to radiation therapy; however, whole‐brain radiotherapy (WBRT) inadequately controls the disease when it is used alone, and its delayed neurotoxicity causes neurocognitive impairment, especially in elderly patients. High‐dose methotrexate (HD‐MTX)–based induction chemotherapy with or without autologous stem cell transplantation (ASCT) or reduced‐dose WBRT leads to durable disease control and less neurotoxicity. The optimal treatment has yet to be defined; however, HD‐MTX–based induction chemotherapy is considered standard for newly diagnosed PCNSL. Ongoing randomized trials are addressing the roles of rituximab and consolidative treatment with ASCT or reduced‐dose WBRT. Despite high tumor response rates with the initial treatment, many patients relapse with a very poor prognosis. The optimal treatment for refractory or relapsed PCNSL is poorly defined. The choice of salvage treatment depends on a patient's age, previous treatment and response, performance status, and comorbidities at the time of relapse. This review provides an overview of the clinical features, diagnosis, pathology, and management of PCNSL in immunocompetent patients, and it focuses on recent advances in treatment. Cancer 2017;123:4314‐24 . © 2017 American Cancer Society . Abstract : Treatment for primary central nervous system lymphoma has advanced significantly with improved survival for this rare and aggressive lymphoma of the central nervous system; however, relapse is common, long‐term survival remains poor, and some treatments are associated with neurotoxicity. Although the optimal treatment approach has yet to be established, high‐dose methotrexate–based chemotherapy is considered the standard induction treatment for newly diagnosed primary central nervous system lymphoma. This review provides an overview of the diagnosis and management of primary central nervous system lymphoma and focuses on recent advances in treatment.