Hickmann Katherine, DiLeo Rachel, Faringer Kathleen, Peterson Chelsea, Wegner Rodney, Horne Zachary, Samhouri Yazan
Drexel University College of Medicine, Philadelphia, PA, USA.
Department of Internal Medicine, Allegheny Health Network, Pittsburgh, PA, USA.
J Hematol. 2025 Apr;14(2):100-104. doi: 10.14740/jh2029. Epub 2025 Apr 11.
Central nervous system lymphoma (CNSL) is an aggressive disease with limited well-studied options for treatment, especially refractory treatment. First-line treatment usually includes high-dose methotrexate (HD-MTX) for induction and either autologous stem cell transplantation or whole-brain radiation therapy (WBRT) as consolidation. However, WBRT can result in significant neurotoxicity, so the use of focal radiation (i.e., gamma knife-stereotactic radiosurgery (GK-SRS)) of varying doses and fractions has been proposed. In the case of refractory disease, chimeric antigen receptor (CAR) T-cell therapy has begun to be used clinically, but patients with CNS involvement were left out of key approval trials. Here, we present a case of a 62-year-old patient with refractory secondary CNSL (SCNSL) previously treated with WBRT who was successfully treated with a combination of CAR T-cell therapy and GK-SRS.
中枢神经系统淋巴瘤(CNSL)是一种侵袭性疾病,可供研究的治疗选择有限,尤其是难治性治疗。一线治疗通常包括大剂量甲氨蝶呤(HD-MTX)诱导治疗,以及自体干细胞移植或全脑放射治疗(WBRT)巩固治疗。然而,WBRT可导致显著的神经毒性,因此有人提出使用不同剂量和分割次数的局部放疗(即伽玛刀立体定向放射外科手术(GK-SRS))。对于难治性疾病,嵌合抗原受体(CAR)T细胞疗法已开始在临床上使用,但中枢神经系统受累的患者被排除在关键的批准试验之外。在此,我们报告一例62岁难治性继发性中枢神经系统淋巴瘤(SCNSL)患者,该患者先前接受过WBRT治疗,经CAR T细胞疗法和GK-SRS联合治疗后获得成功。