Grommes Christian, DeAngelis Lisa M
All authors: Memorial Sloan Kettering Cancer Center, New York, NY.
J Clin Oncol. 2017 Jul 20;35(21):2410-2418. doi: 10.1200/JCO.2017.72.7602. Epub 2017 Jun 22.
Primary CNS lymphoma (PCNSL) is a rare form of extranodal non-Hodgkin lymphoma that is typically confined to the brain, eyes, and cerebrospinal fluid without evidence of systemic spread. The prognosis of patients with PCNSL has improved during the last decades with the introduction of high-dose methotrexate. However, despite recent progress, results after treatment are durable in half of patients, and therapy can be associated with late neurotoxicity. PCNSL is an uncommon tumor, and only four randomized trials and one phase III trial have been completed so far, all in the first-line setting. To our knowledge, no randomized trial has been conducted for recurrent/refractory disease, leaving many questions unanswered about optimal first-line and salvage treatments. This review will give an overview of the presentation, evaluation, and treatment of immunocompetent patients with PCNSL.
原发性中枢神经系统淋巴瘤(PCNSL)是一种罕见的结外非霍奇金淋巴瘤,通常局限于脑、眼和脑脊液,无全身播散证据。在过去几十年中,随着大剂量甲氨蝶呤的应用,PCNSL患者的预后有所改善。然而,尽管最近取得了进展,但仍有一半患者治疗后疗效持久,且治疗可能与迟发性神经毒性相关。PCNSL是一种罕见肿瘤,迄今为止仅完成了四项随机试验和一项III期试验,均为一线治疗。据我们所知,尚未针对复发/难治性疾病进行随机试验,关于最佳一线治疗和挽救治疗仍有许多问题未得到解答。本综述将概述免疫功能正常的PCNSL患者的临床表现、评估和治疗。