Du Steven, Bota Daniela, Kong Xiao-Tang
Bachelor of Arts, University of Southern California, Los Angeles, CA 90089, USA.
Department of Neurology, University of California Irvine, Irvine, CA 92697, USA.
Neurol Int. 2022 Jun 27;14(3):574-580. doi: 10.3390/neurolint14030046.
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive disease that originates from lymphocytes and develops in the central nervous system. There is no standard consolidation/maintenance therapy for PCNSL. While there exists a variety of options, the high chance of inferior outcomes for elderly patients and the risk of neurotoxicity requires exploration of alternative options for consolidation/maintenance therapy for PCNSL in the elderly population with CNS lymphoma. We treated one 77-year-old patient with single agent ibrutinib, a Bruton's tyrosine kinase inhibitor that crosses the blood-brain-barrier, as consolidation/maintenance therapy after induction therapy with high-dose methotrexate (HD-MTX) and rituximab plus temozolomide. This treatment resulted in good tolerance, further resolution of a small residue lymphoma, and sustained remission. The patient has completed one year of consolidation/maintenance therapy and is currently under clinical and imaging surveillance. She has survived 27 months without recurrence since diagnosis. This case shows the potential effectiveness of single agent ibrutinib as consolidation/maintenance therapy for PCNSL after induction therapy. More cases are needed to confirm the findings.
原发性中枢神经系统淋巴瘤（PCNSL）是一种罕见的侵袭性疾病，起源于淋巴细胞，发生于中枢神经系统。目前尚无针对PCNSL的标准巩固/维持治疗方案。虽然有多种选择，但老年患者预后较差的高风险以及神经毒性风险，需要探索针对老年中枢神经系统淋巴瘤患者PCNSL巩固/维持治疗的替代方案。我们对一名77岁患者使用单药伊布替尼（一种可穿越血脑屏障的布鲁顿酪氨酸激酶抑制剂）作为巩固/维持治疗，该患者在接受大剂量甲氨蝶呤（HD-MTX）、利妥昔单抗加替莫唑胺诱导治疗后。这种治疗耐受性良好，小残留淋巴瘤进一步消退，并持续缓解。该患者已完成一年的巩固/维持治疗，目前处于临床和影像学监测中。自诊断以来，她已存活27个月未复发。该病例显示了单药伊布替尼作为诱导治疗后PCNSL巩固/维持治疗的潜在有效性。需要更多病例来证实这些发现。
