Skip to main content

Advertisement

SpringerLink
Log in

Primäre ZNS-Lymphome

Aktuelle Standards bei Diagnostik und Therapie

  • TOPIC 2 • zns-lymphome
  • Published:
best practice onkologie Aims and scope

Zusammenfassung

Primäre ZNS-Lymphome sind in meist aggressive, rasch wachsende Non-Hodgkin-Lymphome vom B-Zell-Typ. Die Diagnostik erfolgt mittels zerebraler Magnetresonanztomographie und stereotaktischer Biopsie. Die Therapie der Wahl besteht heute in erster Linie in der Methotrexat (MTX)-basierten systemischen Chemotherapie. Die Resektion ist nicht indiziert. Langzeitremissionen nach multimodaler Therapie bestehend aus Chemotherapie und Strahlentherapie können durch neurotoxische Spätfolgen überschattet werden. Daher versucht man derzeit, die Chemotherapie zu optimieren. Der Beitrag gibt einen Überblick über aktuelle Diagnostik- und Therapiemöglichkeiten bei primären ZNS-Lymphomen.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Abrey LE, Moskowitz CH, Mason WP et al (2003) Intensive methotrexate and cytarabine followed by high-dose chemotherapy with autologous stem-cell rescue in patients with newly diagnosed primary CNS lymphoma: an intent-to-treat analysis. J Clin Oncol 21:4151–4156

    Article  PubMed  CAS  Google Scholar 

  2. Batchelor T and Loeffler JS (2006) Primary CNS lymphoma. J Clin Oncol 24:1281–1288

    Article  PubMed  CAS  Google Scholar 

  3. Batchelor T, Carson K, O‘Neill A et al (2003) Treatment of primary CNS lymphoma with methotrexate and deferred radiotherapy: a report of NABTT 96-07. J Clin Oncol 21:1044–1049

    Article  PubMed  CAS  Google Scholar 

  4. Bellinzona M, Roser F, Ostertag H et al (2005) Surgical removal of primary central nervous system lymphomas (PCNSL) presenting as space occupying lesions: a series of 33 cases. Eur J Surg Oncol 31:100–105

    Article  PubMed  CAS  Google Scholar 

  5. Correa DD, Maron L, Harder H et al (2007) Cognitive functions in primary central nervous system lymphoma: literature review and assessment guidelines. Ann Oncol 18:1145–1151

    Article  PubMed  CAS  Google Scholar 

  6. Correa DD, Rocco-Donovan M, DeAngelis LM et al (2009) prospective cognitive follow-up in primary CNS lymphoma patients treated with chemotherapy and reduced-dose radiotherapy. J Neurooncol 91:315–321

    Article  PubMed  CAS  Google Scholar 

  7. DeAngelis LM, Seiferheld W, Schold SC et al (2002) Radiation Therapy Oncology Group Study 93-10. Combination chemotherapy and radiotherapy for primary central nervous system lymphoma: Radiation Therapy Oncology Group Study 93-10. J Clin Oncol 20:4643–4648 III

    Article  PubMed  Google Scholar 

  8. Enting RH, Demopoulos A, DeAngelis LM et al (2004) Salvage therapy for primary CNS lymphoma with a combination of rituximab and temozolomide. Neurology 63:901–903

    PubMed  CAS  Google Scholar 

  9. Ferreri AJ, Reni M, Foppoli M et al (2009) High-dose cytarabine plus high-dose methotrexate versus high-dose methotrexate alone in patients with primary CNS lymphoma: a randomised phase 2 trial. Lancet Sept 18 [Epub ahead of print]

  10. Finke J (2009) ZNS Lymphome. V118 DGHO Jahrestagung, Mannheim

  11. Fischer L, Martus P, Weller M et al (2008) Meningeal dissemination in primary CNS lymphoma: Prospective evaluation of 282 patients. Neurology 71:1102–1108

    Article  PubMed  CAS  Google Scholar 

  12. Fischer L, Thiel E, Klasen HA et al (2004) Response of relapsed or refractory primary CNS lymphoma (PCNSL) to topotecan. Neurology 62:1885–188

    PubMed  CAS  Google Scholar 

  13. Gavrilovic IT, Hormigo A, Yaholom J et al (2006) Long-term follow-up of high-dose methotrexate based therapy with and without whole brain irradiation for newly dignosed primary CNS lymphoma. J Clin Oncol 24:4570–4574

    Article  PubMed  CAS  Google Scholar 

  14. Herrlinger U, Küker W, Uhl M et al (2005) NOA-03 multicenter trial of high-dose methotrexate therapy in primary CNS lymphoma: final report. Ann Neurol 57:843–847

    Article  PubMed  CAS  Google Scholar 

  15. Hoang-Xuan K, Taillandier L, Chinot O et al (2003) Chemotherapy alone as initial treatment for primary CNS lymphoma in patients older than 60 years: a multicenter phase II study (26952) of the European Organization for Research and Treatment of Cancer Brain Tumor Group. J Clin Oncol 21:2726–2731

    Article  PubMed  CAS  Google Scholar 

  16. Hoffmann C, Tabrizian S, Wolf E et al (2001) Survival of AIDS patients with primary central nervous system lymphoma is dramatically improved by HAART-induced immune recovery. AIDS 15:2119–2127

    Article  PubMed  CAS  Google Scholar 

  17. Horger M, Fenchel M, Nägele T et al (2009) Water diffusivity: comparson of primary CNS lymphoma and astrocytic tumor infiltrating the corpus callosum. Am J Roentgenol 193:1384–1387

    Article  Google Scholar 

  18. Hottinger AF, DeAngelis LM, Yahalom J et al (2007) Salvage whole brain radiotherapy for recurrent or refractory primary CNS lymphoma. Neurology 69:1178–1182

    Article  PubMed  Google Scholar 

  19. Illerhaus G, Marks R, Ihorst G et al (2006) High-dose chemotherapy with autologous stem-cell transplantation and hyperfractionated radiotherapy as first-line treatment of primary CNS lymphoma. J Clin Oncol 24:3865–3870

    Article  PubMed  CAS  Google Scholar 

  20. Illerhaus G, Muller F, Feuerhake F et al (2008) High-dose chemotherapy and autologous stem-cell transplantation without consolidating radiotherapy as first-line treatment for primary lymphoma of the central nervous system. Haematologica 93:147–148

    Article  PubMed  CAS  Google Scholar 

  21. Illerhaus G, Marks R, Müller F et al (2009) High-dose methotrexate combined with procarbazine and CCNU for primary CNS lymphoma in the elderly: results of a prospective pilot and phase II study. Ann Oncol 20:319–325

    Article  PubMed  CAS  Google Scholar 

  22. Iwamoto FM, Schwartz J, Pandit-Taskar N et al (2007) Study of radiolabeled indium-111 and yttrium-90 ibritumomab tiuxetan in primary central nervous system lymphoma. Cancer 110:2528–2534

    Article  PubMed  CAS  Google Scholar 

  23. Jahnke K, Thiel E, Schilling A et al (2005) Low-grade primary central nervous system lymphoma in immunocompetent patients. Br J Haematol 128: 616–24

    Article  PubMed  Google Scholar 

  24. Jahnke K, Hummel M, Korfel A et al (2006) Detection of subclinical systemic disease in primary CNS lymphoma by polymerase chain reaction of the rearranged immunoglobulin heavy-chain genes. J Clin Oncol 24:4754–4757

    Article  PubMed  CAS  Google Scholar 

  25. Jahnke K, Korfel A, Komm J et al (2006) Intraocular lymphoma 2000–2005: results of a retrospective multicentre trial. Graefes Arch Clin Exp Ophthalmol 244:663–669

    Article  PubMed  Google Scholar 

  26. Jürgens A, Pels H, Rogowski S et al (2009) Long-term Survival with Favorable Cognitive Outcome after Chemotherapy in Primary Central Nervous System Lymphoma. Ann Neurol In press

  27. Küker W, Nägele T, Korfel A et al (2005) Primary central nervous system lymphomas (PCNSL): MRI features at presentation in 100 patients. J Neurooncol 72: 169–77

    Article  PubMed  Google Scholar 

  28. Maza S, Kiewe P, Munz DL et al (2008) First report on a prospective trial with yttrium-90-labeled ibritumomab tiuxetan (ZevalinTM) in primary CNS lymphoma. Neuro Oncol 11:423–429

    Article  PubMed  Google Scholar 

  29. McCann JK, Ashton-Key M, Smith K et al (2009) Primary central nervous system lymphoma: tumor-related clones exist in the blood and bone marrow with evidence for separate development. Blood 113:4677–480

    Article  PubMed  CAS  Google Scholar 

  30. Montesino-Rongen M, Brunn S, Basso K et al (2008) Gene expression profiling suggests primary central nervous system lymphomas to be derived from late germinal center B cell. Leukemia 22:400–405

    Article  CAS  Google Scholar 

  31. Nguyen PL, Chakravarti A, Finkelstein DM et al (2005) Results of whole-brain radiation as salvage of methotrexate failure for immunocompetent patients with primary CNS lymphoma. J Clin Oncol 23:1507–1513

    Article  PubMed  Google Scholar 

  32. O'Brien P, Roos D, Pratt G et al (2000) Phase II multicenter study of brief single-agent methotrexate followed by irradiation in primary CNS lymphoma. J Clin Oncol 18:519–526

    PubMed  Google Scholar 

  33. Omuro AM, Taillandier L, Chinot O et al (2007) Temozolomide and methotrexate for primary central nervous system lymphoma in the elderly. J Neurooncol 85:207–211

    Article  PubMed  CAS  Google Scholar 

  34. Pels H, Schmidt-Wolf IG, Glasmacher A et al (2003) Primary central nervous system lymphoma: results of a pilot and phase II study of systemic and intraventricular chemotherapy with deferred radiotherapy. J Clin Oncol 21:4489–4495

    Article  PubMed  CAS  Google Scholar 

  35. Pels H, Schulz H, Schlegel U, Engert A (2003) Treatment of CNS lymphoma with the anti-CD20 antibody rituximab: experience with two cases and review of the literature. Onkologie 26:351–354

    Article  PubMed  CAS  Google Scholar 

  36. Pels H, Juergens A, Glasmacher A et al (2009) Early relapses in primary CNS lymphoma after response to polychemotherapy without intraventricular treatment: results of a phase II study. J Neurooncol 91:299–305

    Article  PubMed  CAS  Google Scholar 

  37. Poortmans PM, Kluin-Nelemans HC, Haaxma-Reiche H et al (2003) High-dose methotrexate-based chemotherapy followed by consolidating radiotherapy in non-AIDS-related primary central nervous system lymphoma: European Organization for Research and Treatment of Cancer Lymphoma Group Phase II Trial20962. J Clin Oncol 21: 4483–4488 III

    Article  PubMed  CAS  Google Scholar 

  38. Porter AB, Giannini C, Kaufmann T et al (2008) Primary central nervous system lymphoma can be diagnosed after previous corticosteroid use: a pilot study to determine whether corticosteroids prevent the diagnosis of primary central nervous system lymphoma. Ann Neurol 63: 662–667

    Article  PubMed  CAS  Google Scholar 

  39. Reni M, Mazza E, Foppoli M et al (2007) Primary central nervous system lymphomas: salvage treatment after failure to high-dose methotrexate. Cancer Lett 258:165–170

    Article  PubMed  CAS  Google Scholar 

  40. Rubenstein JL, Fridlyand J, Abrey L, et al. (2007): Phase I study of intraventricular administration of rituximab in patients with recurrent CNS and intraocular lymphoma. J Clin Oncol 25:1350–1356

    Article  PubMed  CAS  Google Scholar 

  41. Schlegel U, Thiel E (2008) Zerebrale Lymphome. In: Kurzgefasste interdisziplinäre Leitlinien. Deutsche Krebsgesellschaft. Zuckschwerdt, München 188–194

  42. Schlegel U, Korfel A, Thiel E et al (2009) Primäre ZNS Lymphome. Onkologe 15: 211–221

    Article  Google Scholar 

  43. Shah GD, Yahalom J, Correa DD, et al. (2007): Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol 25:4730–4735

    Article  PubMed  CAS  Google Scholar 

  44. Shenkier TN, Blay JY, O'Neill BP, et al. (2005): Primary CNS lymphoma of T-cell origin: a descriptive analysis from the international primary CNS lymphoma collaborative group. J Clin Oncol 23:2233–2239

    Article  PubMed  Google Scholar 

  45. Shibamoto Y, Ogino H, Hasegawa M, et al. (2005): Results of radiation monotherapy for primary central nervous system lymphoma in the 1990s. Int J Radiat Oncol Biol Phys 62:809–813

    PubMed  Google Scholar 

  46. Smith JR, Rosenbaum JT, Wilson DJ, et al. (2002): Role of intravitreal methotrexate in the management of primary central nervous system lymphoma with ocular involvement. Ophthalmology 109:1709–1716

    Article  PubMed  Google Scholar 

  47. Soussain C, Hoang-Xuan K, Taillandier L, et al. (2008): Intensive chemotherapy followed by hematopoietic stem-cell rescue for refractory and recurrent primary CNS and intraocular lymphoma: Societe Francaise de Greffe de Moelle Osseuse-Therapie Cellulaire. J Clin Oncol 26:2512–2518

    Article  PubMed  Google Scholar 

  48. Zhu JJ, Gerstner ER, Engler DA, et al. (2009): High-dose methotraxate for elderly patients with primary CNS lymphoma. Neuro-Oncol 11:211–215

    Article  PubMed  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Neurologische Klinik am Knappschaftskrankenhaus Bochum-Langendreer, Klinikum der Ruhr-Universität Bochum, Bochum, Germany

    Uwe Schlegel

  2. Medizinische Klinik III, Charité Berlin, Campus Benjamin Franklin, Berlin, Germany

    Agnieszka Korfel

  3. Klinik für Strahlentherapie und Radioonkologie, Universitätsklinikum Leipzig, Leipzig, Germany

    Rolf Kortmann

  4. Institut für Neuropathologie, Universitätsklinik Köln, Köln, Germany

    Martina Deckert

  5. Neurochirurgische Klinik, Universitätsklinikum Carl Gustav Carus, Technische Universität Dresden, Dresden, Germany

    Gabriele Schackert

  6. Knappschaftskrankenhaus Bochum-Langendreer, Ruhr-Universität Bochum, In der Schornau 23-25, 44892, Bochum, Germany

    Uwe Schlegel

Authors
  1. Uwe Schlegel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Agnieszka Korfel
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Rolf Kortmann
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Martina Deckert
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Gabriele Schackert
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Uwe Schlegel.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Schlegel, U., Korfel, A., Kortmann, R. et al. Primäre ZNS-Lymphome. best practice onkologie 5, 26–35 (2010). https://doi.org/10.1007/s11654-009-0194-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11654-009-0194-4

Search

Navigation