Faculty of 1000 evaluation for Surgery for primary CNS lymphoma? Challenging a paradigm.

Abstract High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation (HDT-ASCT) is listed as a consolidation therapy option for primary central nervous system (CNS) lymphoma in the guidelines of western countries. The advantages of HDT-ASCT for primary CNS lymphoma as consolidation are believed to be high rates of long-term remission and lower neurotoxicity, even though its eligibility is limited to younger fit patients. In the Japanese guideline, HDT-ASCT for primary CNS lymphoma is however not recommended in daily practice, mainly because thiotepa was unavailable since 2011. The Japanese registry data for hematopoietic transplantation have shown that primary CNS lymphoma patients were treated with various HDT regimens and thiotepa-containing HDT was associated with better progression free survival (P=.019), lower relapse (P=.042) and a trend toward a survival benefit (Kondo E et al, Biol Blood Marrow Transplant 2019). A pharmacokinetic study of thiotepa(DSP-1958) in HDT-ASCT for lymphoma was conducted in 2017, and thiotepa was approved for HDT-ASCT in lymphoma this March, meaning that optimal HDT regimen for CNS lymphoma is now available in Japan. The treatment strategy of CNS lymphoma needs further development to improve survival and reduce toxicity.

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Differentiation of Primary CNS lymphoma and High-grade glioma with Dynamic Susceptibility Contrast derived metrics: A Pilot Study

World Neurosurgery ◽

10.1016/j.wneu.2021.05.026 ◽

2021 ◽

Author(s):

Joga Chaganti ◽

Michael Taylor ◽

Hannah Woodford ◽

Timothy Steel

Keyword(s):

Pilot Study ◽

Primary Cns Lymphoma ◽

High Grade Glioma ◽

Cns Lymphoma ◽

Dynamic Susceptibility ◽

High Grade ◽

Dynamic Susceptibility Contrast ◽

Susceptibility Contrast

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Treatment of HIV-associated primary CNS lymphoma with antiretroviral therapy, rituximab, and high-dose methotrexate

Blood ◽

10.1182/blood.2020006048 ◽

2020 ◽

Vol 136 (19) ◽

pp. 2229-2232

Author(s):

Kathryn Lurain ◽

Thomas S. Uldrick ◽

Ramya Ramaswami ◽

Mark N. Polizzotto ◽

Priscila H. Goncalves ◽

...

Keyword(s):

Antiretroviral Therapy ◽

Primary Cns Lymphoma ◽

Cns Lymphoma ◽

High Dose ◽

High Dose Methotrexate ◽

Dose Methotrexate

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Consensus Recommendations for MRI and PET Imaging of Primary Central Nervous System Lymphoma: Guideline Statement from the International Primary CNS Lymphoma Collaborative Group (IPCG)

Neuro-Oncology ◽

10.1093/neuonc/noab020 ◽

2021 ◽

Cited By ~ 1

Author(s):

Ramon F Barajas Jr ◽

Letterio S Politi ◽

Nicoletta Anzalone ◽

Heiko Schöder ◽

Christopher P Fox ◽

...

Keyword(s):

Central Nervous System ◽

Nervous System ◽

Tumor Imaging ◽

Primary Cns Lymphoma ◽

Central Nervous System Lymphoma ◽

Response Assessment ◽

Integrated Approach ◽

Collaborative Group ◽

Cns Lymphoma ◽

Consensus Recommendations

Abstract Advanced molecular and pathophysiologic characterization of Primary Central Nervous System Lymphoma (PCNSL) has revealed insights into promising targeted therapeutic approaches. Medical imaging plays a fundamental role in PCNSL diagnosis, staging, and response assessment. Institutional imaging variation and inconsistent clinical trial reporting diminishes the reliability and reproducibility of clinical response assessment. In this context, we aimed to: 1) critically review the use of advanced PET and MRI in the setting of PCNSL; 2) provide results from an international survey of clinical sites describing the current practices for routine and advanced imaging, and 3) provide biologically based recommendations from the International PCNSL Collaborative Group (IPCG) on adaptation of standardized imaging practices. The IPCG provides PET and MRI consensus recommendations built upon previous recommendations for standardized brain tumor imaging protocols (BTIP) in primary and metastatic disease. A biologically integrated approach is provided to addresses the unique challenges associated with the imaging assessment of PCNSL. Detailed imaging parameters facilitate the adoption of these recommendations by researchers and clinicians. To enhance clinical feasibility, we have developed both “ideal” and “minimum standard” protocols at 3T and 1.5T MR systems that will facilitate widespread adoption.

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High-dose methotrexate-based regimens and post-remission consolidation for treatment of newly diagnosed primary CNS lymphoma: meta-analysis of clinical trials

Scientific Reports ◽

10.1038/s41598-020-80724-0 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Junyao Yu ◽

Huaping Du ◽

Xueshi Ye ◽

Lifei Zhang ◽

Haowen Xiao

Keyword(s):

Meta Analysis ◽

Primary Cns Lymphoma ◽

Central Nervous System Lymphoma ◽

Progression Free Survival ◽

Complete Response ◽

Cns Lymphoma ◽

High Dose ◽

High Dose Methotrexate ◽

Newly Diagnosed ◽

Dose Methotrexate

AbstractWith the exception of high-dose methotrexate (HD-MTX), there is currently no defined standard treatment for newly diagnosed primary central nervous system lymphoma (PCNSL). This review focused on first-line induction and consolidation treatment of PCNSL and aimed to determine the optimal combination of HD-MTX and the long-term beneficial consolidation methods. A comprehensive literature search of MEDLINE identified 1407 studies, among which 31 studies met the inclusion criteria. The meta-analysis was performed by using Stata SE version 15. Forest plots were generated to report combined outcomes like the complete response rate (CRR), overall survival, and progression-free survival. We also conducted univariate regression analyses of the baseline characteristics to identify the source of heterogeneity. Pooled analysis showed a CRR of 41% across all HD-MTX-based regimens, and three- and four-drug regimens had better CRRs than HD-MTX monotherapy. In all combinations based on HD-MTX, the HD-MTX + procarbazine + vincristine (MPV) regimen showed pooled CRRs of 63% and 58% with and without rituximab, respectively, followed by the rituximab + HD-MTX + temozolomide regimen, which showed a pooled CRR of 60%. Pooled PFS and OS showed that post-remission consolidation with autologous stem cell transplantation (ASCT) was associated with the best survival outcome, with a pooled 2-year OS of 80%, a 2-year PFS of 74%, a 5-year OS of 77%, and a 5-year PFS of 63%. Next, whole-brain radiation therapy (WBRT) + chemotherapy showed a pooled 2-year OS of 72%, 2-year PFS of 56%, 5-year OS of 55%, and 5-year PFS of 41%, with no detectable CR heterogeneity throughout the entire treatment process. In HD-MTX-based therapy of newly diagnosed PCNSL, MPV with or without rituximab can be chosen as the inductive regimen, and the rituximab + HD-MTX + temozolomide regimen is also a practical choice. Based on our study, high-dose chemotherapy supported by ASCT is an efficacious approach for consolidation. Consolidation with WBRT + chemotherapy can be another feasible approach.

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