A narrative review of consolidation strategies for young and fit patients with newly-diagnosed primary central nervous system lymphoma

2021 ◽  
Author(s):  
Sara Steffanoni ◽  
Teresa Calimeri ◽  
Nicoletta Anzalone ◽  
Sara Mastaglio ◽  
Massimo Bernardi ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Narrative Review ◽  
Newly Diagnosed

scholarly journals Challenges in the Treatment of Newly Diagnosed and Recurrent Primary Central Nervous System Lymphoma

2020 ◽  
Vol 18 (11) ◽  
pp. 1571-1578
Author(s):  
Matthias Holdhoff ◽  
Maciej M. Mrugala ◽  
Christian Grommes ◽  
Thomas J. Kaley ◽  
Lode J. Swinnen ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
B Cell ◽  
Central Nervous System Lymphoma ◽  
High Dose Chemotherapy ◽  
High Dose ◽  
Newly Diagnosed ◽  
Phase Ii Trials ◽  
Whole Brain Radiation ◽  
The Central Nervous System

Primary central nervous system lymphomas (PCNSLs) are rare cancers of the central nervous system (CNS) and are predominantly diffuse large B-cell lymphomas of the activated B-cell (ABC) subtype. They typically present in the sixth and seventh decade of life, with the highest incidence among patients aged >75 years. Although many different regimens have demonstrated efficacy in newly diagnosed and relapsed or refractory PCNSL, there have been few randomized prospective trials, and most recommendations and treatment decisions are based on single-arm phase II trials or even retrospective studies. High-dose methotrexate (HD-MTX; 3–8 g/m2) is the backbone of preferred standard induction regimens. Various effective regimens with different toxicity profiles can be considered that combine other chemotherapies and/or rituximab with HD-MTX, but there is currently no consensus for a single preferred regimen. There is controversy about the role of various consolidation therapies for patients who respond to HD-MTX–based induction therapy. For patients with relapsed or refractory PCNSL who previously experienced response to HD-MTX, repeat treatment with HD-MTX–based therapy can be considered depending on the timing of recurrence. Other more novel and less toxic regimens have been developed that show efficacy in recurrent disease, including ibrutinib, or lenalidomide ± rituximab. There is uniform agreement to delay or avoid whole-brain radiation therapy due to concerns for significant neurotoxicity if a reasonable systemic treatment option exists. This article aims to provide a clinically practical approach to PCNSL, including special considerations for older patients and those with impaired renal function. The benefits and risks of HD-MTX or high-dose chemotherapy with autologous stem cell transplantation versus other, better tolerated strategies are also discussed. In all settings, the preferred treatment is always enrollment in a clinical trial if one is available.

scholarly journals Magnetic resonance and its diagnostic accuracy of glioblastoma: narrative review

2021 ◽  
Author(s):  
Pedro da Cunha Dantas ◽  
Lucas Pablo Almendro ◽  
Ana Caroline Fonseca Silva ◽  
André Douglas Marinho da Silva
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Magnetic Resonance ◽  
Diffusion Tensor ◽  
Central Nervous System Lymphoma ◽  
Narrative Review ◽  
Differential Diagnoses ◽  
Key Words Glioblastoma ◽  
Pubmed Database ◽  
Magnetic Resonance Imaging Mri

Introduction: Glioblastoma (GBM) is the most common and lethal Central Nervous System (CNS) malignant cancer, and the exclusion of differential diagnoses - eg primary central nervous system lymphoma (PCNSL) - often occurs via various Magnetic Resonance Imaging (MRI) methodologies. Objective: To describe which best image sequences are critical for greater accuracy in the diagnosis of GBM and for their distinction from other CNS tumors. Methods: This is a literature narrative review, initiated by research in Pubmed database, using associated Key words: “Glioblastoma” and “Magnetic Resonance”; and filters: systematic reviews + last 5 years publications. Productions that didn’t meet the objective were discarded. Results: MRI has accuracy for diagnosing GBM using the combination T2 + FLAIR + T1 with pre and post-gadolinic contrast. Diffusion and perfusion-weighted MRI association show an improvement in specificity. Computed tomography is used when MRI is unviable, identifying calcifications or hemorrhages and determining the lesion location and surgical potential. Also, spectroscopic MRI, diffusion tensor imaging and PET 18F-FDG, and 11C-MET were reported as important additional diagnostic criteria. Diffusion MRI (DWI) is a non-invasive, convenient, economical, and quick procedure when compared to GBM biopsy. Therefore, adding reliable evidence for moderate differentiation between GBM and PCNSL through DWI. Conclusion: Reliable methods are needed for GBM accurate diagnosis and its differential diagnoses, using at least T2 + FLAIR + T1, and physiological exams to enhance specificity.

scholarly journals The Impact of Early Corticosteroid Pretreatment Before Initiation of Chemotherapy in Patients With Primary Central Nervous System Lymphoma

Neurosurgery ◽  
2018 ◽  
Vol 85 (2) ◽  
pp. 264-272 ◽  
Author(s):  
Florian Gessler ◽  
Joshua D Bernstock ◽  
Bedjan Behmanesh ◽  
Uta Brunnberg ◽  
Patrick Harter ◽  
...  
Keyword(s):  
Central Nervous System ◽  
Nervous System ◽  
Central Nervous System Lymphoma ◽  
Chemotherapeutic Agents ◽  
Optimal Timing ◽  
Newly Diagnosed ◽  
Chemotherapeutic Regimen ◽  
P 75 ◽  
Response To Chemotherapy ◽  
The Impact

Abstract BACKGROUND The optimal timing of corticosteroid (CS) treatment in patients with primary central nervous system (CNS) lymphoma (PCNSL) remains controversial. While poor clinical presentation may justify early treatment with CS, this may ultimately result in reduced concentrations of chemotherapeutic agents via perturbations in the permeability of the blood-brain barrier. OBJECTIVE To investigate whether early CS exposure is associated with beneficial outcomes and/or reduced occurrence of adverse events as opposed to delayed/concomitant administration. METHODS Herein we performed a retrospective observational analysis using patients that were prospectively entered into a database. All patients whom were admitted to the University Hospital between 2009 and 2015 with newly diagnosed PCNSL were included within our study. RESULTS Our cohort included 50 consecutive patients diagnosed with PCNSL; of these, in 30 patients CS administration was initiated prior to chemotherapy (early), whilst in the remaining 20 patients CS administration was initiated concomitantly with their chemotherapeutic regimen (concomitant). Within the early vs concomitant CS administration groups, no significant differences were observed with regard to progression-free survival (PFS) (P = .81), overall survival (OS) (P = .75), or remission (P = .68; odds ratio 0.76 and confidence interval [95%] 0.22-2.71). Critically, the timing of CS initiation was not associated with either PFS (P = .81) or PFS (P = .75). CONCLUSION Early CS administration was not associated with a deterioration in response to chemotherapy, PFS, or OS. As such, administration of CS prior to initiation of chemotherapy is both reasonable and safe for patients with newly diagnosed PCNSL.

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