Skip to main content
SpringerLink
Log in

Primäre Zentralnervensystemlymphome (PZNSL)

  • Chapter
  • First Online:
Weiterbildung Onkologie

  • 1623 Accesses

Zusammenfassung

Das PZNSL macht etwa 2% aller intrakraniellen Tumoren aus. Histologisch handelt es sich ganz überwiegend um diffuse großzellige B-Zell-Lymphome. Von nodalen Lymphomen mit der gleichen Histologie unterscheidet sich das PZNSL durch seine starke ZNS-Affinität mit geringer Neigung zur systemischen Ausbreitung, sehr aggressiven Verlauf und ungewöhnliche Empfindlichkeit auf Hochdosismethotrexat (HDMTX). HDMTX ist daher das wichtigste Therapieelement bei PZNSL, wobei das optimale Protokoll aufgrund der Seltenheit der Erkrankung bisher nicht etabliert ist. Die wichtigsten Prognosefaktoren sind Alter und Allgemeinzustand. Bei jüngeren Patienten sollten intensivierte Chemotherapieprotokolle mit kurativem Behandlungsziel eingesetzt werden. Bei älteren Patienten ist eine Heilung meist nicht möglich, und die Therapie bedarf dringend einer Optimierung. Ein wichtiges Ziel bei allen Patienten mit PZNSL ist die Vermeidung einer potenziell schweren therapieassoziierten ZNS-Toxizität.

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

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 17.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. Korfel A, Schlegel U (2013) Diagnosis and treatment of primary CNS lymphoma. Nat Rev Neurol 9:317–327

    Article  PubMed  CAS  Google Scholar 

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

    Article  Google Scholar 

  3. Korfel A, Weller M, Plasswilm L et al (2001) Primäre ZNS-Lymphome des immunkompetenten Patienten. Onkologe 7:990–997

    Article  Google Scholar 

  4. Deckert M, Engert A, Brück W et al (2011) Modern concepts in the biology, diagnosis, differential diagnosis and treatment of primary central nervous system lymphoma. Leukemia 25:1797–1807

    Article  PubMed  CAS  Google Scholar 

  5. Hensel M, Goetzenich A, Lutz T et al (2011) HIV und Krebs in Deutschland. Dtsch Arztebl 107:117–122

    Google Scholar 

  6. Korfel A, Weller M, Martus P et al (2012) Prognostic impact of meningeal dissemination in primary CNS lymphoma (PCNSL): experience from the G-PCNSL-SG1 trial. Ann Oncol 23:2374–2380

    Article  PubMed  CAS  Google Scholar 

  7. Baraniskin A, Kuhnhenn J, Schlegel U et al (2011) Identification of microRNAs in the cerebrospinal fluid as marker for primary diffuse large B-cell lymphoma of the central nervous system. Blood 117:3140–3146

    Article  PubMed  CAS  Google Scholar 

  8. Abrey LE, Batchelor TT, Ferreri AJ et al (2005) Report of an international workshop to standardize baseline evaluation and response criteria for primary CNS lymphoma. J Clin Oncol 23:5034–5043

    Article  PubMed  Google Scholar 

  9. Thiel E, Korfel A, Martus P et al (2010) High-dose methotrexate with or without whole brain radiotherapy for primary CNS lymphoma (GPCNSL- SG-1): a phase 3, randomised, non-inferiority trial. Lancet Oncol 11:1036–1047

    Article  PubMed  CAS  Google Scholar 

  10. Weller M, Martus P, Roth P et al (2012) Surgery for primary CNS lymphoma? Challenging a paradigm. Neuro Oncol 14:1481–1484

    Article  PubMed  PubMed Central  Google Scholar 

  11. Nelson DF, Martz KL, Bonner H et al (1992) Non-Hodgkin†²s lymphoma of the brain: can high dose, large volume radiation therapy improve survival? Report on a prospective trial by the Radiation Oncology Group (RTOG): RTOG 8315. Int J Radiat Oncol Biol Phys 23:9–17

    Article  PubMed  CAS  Google Scholar 

  12. 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

    Article  PubMed  Google Scholar 

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

    Article  PubMed  Google Scholar 

  14. OBrien PC, Roos DE, Pratt G et al (2006) Combined modality therapy for primary central nervous system lymphoma: long-term data from a phase II multicenter study (Trans- Tasman Radiation Oncology Group)Int J Radiat Oncol Biol Phys. 64:408–413

    Google Scholar 

  15. Poortmans PM, Kluin-Nelemans HC, Haaxma-Reiche H et al (2003) Highdose 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 trial 20962. J Clin Oncol 21:4483–4488

    Article  PubMed  CAS  Google Scholar 

  16. Korfel A, Martus P, Nowrousian MR et al (2005) German Primary Central Nervous System Lymphoma Study Group (G-PCNSL-SG). Response to chemotherapy and treating institution predict survival in primary central nervous system lymphoma. Br J Haematol 128:177–183

    Article  PubMed  Google Scholar 

  17. Ferreri AJ, Dell’Oro S, Foppoli M et al (2006) MATILDE regimen followed by radiotherapy is an active strategy against primary CNS lymphomas. Neurology 66:1435–1438

    Article  PubMed  CAS  Google Scholar 

  18. Ferreri AJ, Reni M, Pasini F et al (2002) A multicenter study of treatment of primary CNS lymphoma. Neurology 58:1513–1520

    Article  PubMed  CAS  Google Scholar 

  19. Ekenel M, Iwamoto FM, Ben-Porat LS et al (2008) Primary central nervous system lymphoma: the role of consolidation treatment after a complete response to high-dose methotrexate- based chemotherapy. Cancer 113:1025–1031

    Article  PubMed  CAS  Google Scholar 

  20. Mead GM, Bleehen NM, Gregor A et al (2000) A medical research council randomized trial in patients with primary cerebral non-Hodgkin lymphoma: cerebral radiotherapy with and without cyclophosphamide, doxorubicin, vincristine, and prednisone chemotherapy. Cancer 89:1359–1370

    Article  PubMed  CAS  Google Scholar 

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

    Article  PubMed  CAS  Google Scholar 

  22. Batchelor T, Carson K, O†²Neill 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 

  23. 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 374:1512–1520

    Article  PubMed  CAS  Google Scholar 

  24. 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 

  25. Juergens A, Pels H, Rogowski S et al (2010) Long-term survival with favorable cognitive outcome after chemotherapy in primary central nervous system lymphoma. Ann Neurol 67:182–1899

    Article  PubMed  CAS  Google Scholar 

  26. Rubenstein JL, Hsi ED, Johnson JL et al (2013) Intensive chemotherapy and immunotherapy in patients with newly diagnosed primary CNS lymphoma: CALGB 50202 (Alliance 50202). J Clin Oncol 31(25):3061–3068

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  27. Deutsche Gesellschaft für Neurologie (2012) Kapitel Hirntumoren. Primäre ZNS-Lymphome (PZNSL). AWMF-Leitlinienregisternummer 030-059. AWMF, Düsseldorf, http://www.awmf.org/uploads/tx_szleitlinien/030-059l_S1_Primare_ZNS_Lymphome_2012. Zugegriffen: 06.11.2013

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

    Article  PubMed  CAS  Google Scholar 

  29. Chamberlain MC, Johnston SK (2010) High-dose methotrexate and rituximab with deferred radiotherapy for newly diagnosed primary B-cell CNS lymphoma. Neuro Oncol 12:736–744

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  30. 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 

  31. Khan RB, Shi W, Thaler HT et al (2002) Is intrathecal methotrexate necessary in the treatment of primary CNS lymphoma? J Neurooncol 58:175–178

    Article  PubMed  Google Scholar 

  32. Sierra Del Rio M, Ricard D, Houillier C et al (2012) Prophylactic intrathecal chemotherapy in primary CNS lymphoma. J Neurooncol 106:143–146

    Article  PubMed  CAS  Google Scholar 

  33. 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 

  34. 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 

  35. Illerhaus G, Müller 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 

  36. Roth P, Martus P, Kiewe P et al (2012) Outcome of elderly patients with primary CNS lymphoma in the G-PCNSL-SG-1 trial. Neurology 79(9):890–896

    Article  PubMed  Google Scholar 

  37. Daras M, DeAngelis LM (2013) Management of elderly patients with primary central nervous system lymphoma. Curr Neurol Neurosci Rep 13(5):344

    Article  PubMed  Google Scholar 

  38. 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 

  39. Abrey LE, DeAngelis LM, Yahalom J (1998) Long-term survival in primary CNS lymphoma. J Clin Oncol 16:859–863

    PubMed  CAS  Google Scholar 

  40. Omuro AM, Ben-Porat LS, Panageas KS et al (2005) Delayed neurotoxicity in primary central nervous system lymphoma. Arch Neurol 62:1595–1600

    Article  PubMed  Google Scholar 

  41. Correa DD, Shi W, Abrey LE et al (2012) Cognitive functions in primary CNS lymphoma after single or combined modality treatments. Neuro Oncol 14:101–108

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  42. Doolittle ND, Korfel A, Lubow MA et al (2013) Long-term cognitive function, neuroimaging, and quality of life in primary CNS lymphoma. Neurology 81:84–92

    Article  PubMed  CAS  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik für Hämatologie, Onkologie und Tumorimmunologie , Charité- Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200, Berlin, Deutschland

    PD Dr. A. Korfel

  2. Kinik für Neurologie,Knappschaftskrankenhaus, Neurologische Universitätsklinik, Ruhruniversität Bochum, n der Schornau 23–25, 44892, Bochum, Deutschland

    Prof. Dr. U. Schlegel

Authors
  1. PD Dr. A. Korfel
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Prof. Dr. U. Schlegel
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to A. Korfel .

Editor information

Editors and Affiliations

  1. Klinik für Strahlentherapie und Radio-Onkologie, Ruhr-Universität Bochum, Marienhospital Herne, Herne, Germany

    Irenäus A. Adamietz

  2. Klinik für Allgemein- und Viszeralchirurgie, Universitätsklinikum Frankfurt, Frankfurt, Germany

    Wolf O. Bechstein

  3. Klinik für Strahlentherapie und Spezielle Onkologie, Medizinische Hochschule Hannover, Hannover, Germany

    Hans Christiansen

  4. Urologikum Lübeck, Lübeck, Germany

    Christian Doehn

  5. Klinik für Innere Medizin II, Universitätsklinikum Jena, Jena, Germany

    Andreas Hochhaus

  6. TagesTherapieZentrum (TTZ), Universitätsmedizin Mannheim, Mannheim, Germany

    Ralf-Dieter Hofheinz

  7. Klinik für Gynäkologie, Charité - Universitätsmedizin Berlin, Berlin, Germany

    Werner Lichtenegger

  8. Klinik für Dermatologie, Universitätsklinikum Essen, Essen, Germany

    Dirk Schadendorf

  9. Klinik für Gynäkologie und Geburtshilfeum, HELIOS Klinikum Berlin-Buch, Berlin, Germany

    Michael Untch

  10. Institut für Pathologie, Universitätsklinikum Leipzig, Leipzig, Germany

    Christian F. Wittekind

Rights and permissions

Reprints and permissions

Copyright information

© 2015 Springer-Verlag Berlin Heidelberg

About this chapter

Cite this chapter

Korfel, A., Schlegel, U. (2015). Primäre Zentralnervensystemlymphome (PZNSL). In: Adamietz, I., et al. Weiterbildung Onkologie. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-44835-9_13

Download citation

  • DOI: https://doi.org/10.1007/978-3-662-44835-9_13

  • Published:

  • Publisher Name: Springer, Berlin, Heidelberg

  • Print ISBN: 978-3-662-44834-2

  • Online ISBN: 978-3-662-44835-9

  • eBook Packages: Medicine (German Language)

Publish with us

Policies and ethics

Search

Navigation