Losi Giulia, Mussetti Alberto, Peña Marta, Lopez-Pereira Patricia, Sureda Anna, Novelli Silvana
Clinical Hematology Department, Institut Català d'Oncologia-L' Hospitalet, IDIBELL, Barcelona, Spain.
Department of Molecular Medicine, University of Pavia, Pavia, Italy.
Bone Marrow Transplant. 2025 Mar;60(3):259-269. doi: 10.1038/s41409-024-02496-9. Epub 2024 Dec 14.
Central nervous system lymphomas (CNSL) are a heterogeneous group of generally aggressive tumors whose prognosis varies significantly, being more favorable in patients with primary disease and poorer in those with secondary lymphoma. Current treatments typically involve intensive chemotherapy followed by consolidation with autologous stem cell transplantation or whole-brain radiotherapy. However, if the disease relapses, there is no established standard of care. The recent approval of anti-CD19 chimeric antigen receptor (CAR) T-cell therapy for systemic B-cell lymphomas has shifted the treatment landscape for previously incurable patients. Even though this therapy was initially underexplored in the setting of CNSL due to safety and efficacy concerns, it could offer a new therapeutic avenue for these patients. In this review, we will provide a concise overview of the current treatment strategies for CNSL, highlighting their key limitations, including relapse rates and long-term toxicity. Following this, we will explore the most important studies and clinical trials on CNSL, focusing on recent advancements in anti-CD19 CAR T-cell therapy. This comprehensive analysis will offer insights into the successes and challenges of treating CNSL effectively.
中枢神经系统淋巴瘤（CNSL）是一组异质性肿瘤，通常具有侵袭性，其预后差异很大，原发性疾病患者的预后较好，继发性淋巴瘤患者的预后较差。目前的治疗通常包括强化化疗，随后进行自体干细胞移植巩固治疗或全脑放疗。然而，如果疾病复发，则没有既定的标准治疗方案。抗CD19嵌合抗原受体（CAR）T细胞疗法最近被批准用于治疗系统性B细胞淋巴瘤，这改变了以前无法治愈患者的治疗格局。尽管由于安全性和有效性问题，这种疗法最初在CNSL的治疗中未得到充分探索，但它可能为这些患者提供一条新的治疗途径。在这篇综述中，我们将简要概述CNSL目前的治疗策略，强调其主要局限性，包括复发率和长期毒性。在此之后，我们将探讨关于CNSL最重要的研究和临床试验，重点关注抗CD19 CAR T细胞疗法的最新进展。这一全面分析将深入了解有效治疗CNSL的成功经验和挑战。
