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Treatment of Primary Central Nervous System Lymphoma in Immunocompetent Patients

  • Neuro-oncology (R Soffietti, Section Editor)
  • Published:
Current Treatment Options in Neurology Aims and scope Submit manuscript

Abstract

Purpose of review

This review focuses on the findings of recent randomized prospective trials evaluating new therapeutic options for primary central nervous system lymphoma (PCNSL) in first-line treatment and on the most promising novel agents.

Recent findings

The current standard treatment of newly diagnosed PCNSL has long been depending on high-dose methotrexate (HD-MTX)–based polychemotherapy followed by whole-brain radiotherapy (WBRT). Recent randomized trials have provided evidence that high-dose chemotherapy with autologous stem cell transplantation (ASCT) is a valuable alternative option to WBRT as consolidation after induction HD-MTX–based chemotherapy. For the elderly, cumulative studies confirm that chemotherapy alone as initial treatment is the best approach in this frail population in order to reduce chemoradiation neurotoxicity. If the role of rituximab needs to be further investigated, novel agents such as imids and ibrutinib have shown to be promising drugs to be incorporated in innovative combination treatment.

Summary

The role of WBRT, at least at conventional dose, is declining in first-line treatment in favor of intensive consolidation chemotherapy with or without ASCT and possibly maintenance chemotherapy in the elderly. Despite their rarity, it has been shown that ambitious randomized trials in PCNSL are feasible thanks to collaborative networks.

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Authors and Affiliations

  1. AP-HP, Department of Neurology-2, Groupe Hospitalier Pitié Salpêtrière, Paris, France

    Ytel Garcilazo-Reyes MD, Agusti Alentorn MD, PhD, Alberto Duran-Pena MD, Khê Hoang-Xuan MD, PhD & Caroline Houillier MD

  2. Sorbonne Université, Paris, France

    Ytel Garcilazo-Reyes MD, Agusti Alentorn MD, PhD, Alberto Duran-Pena MD, Khê Hoang-Xuan MD, PhD & Caroline Houillier MD

  3. LOC Network for PCNSL, Paris, France

    Agusti Alentorn MD, PhD, Khê Hoang-Xuan MD, PhD & Caroline Houillier MD

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  1. Ytel Garcilazo-Reyes MD
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  2. Agusti Alentorn MD, PhD
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  3. Alberto Duran-Pena MD
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Correspondence to Khê Hoang-Xuan MD, PhD.

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Garcilazo-Reyes, Y., Alentorn, A., Duran-Pena, A. et al. Treatment of Primary Central Nervous System Lymphoma in Immunocompetent Patients. Curr Treat Options Neurol 21, 39 (2019). https://doi.org/10.1007/s11940-019-0578-x

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