Guidelines for the diagnosis and management of primary central nervous system diffuse large B‐cell lymphoma

Fox, Christopher P.; Phillips, Elizabeth H; Smith, Jeffery; Linton, Kim; Gallop‐Evans, Eve; Hemmaway, Claire; Auer, Dorothee P.; Fuller, Charlotte; Davies, Andrew; McKay, Pam; Cwynarski, Kate

doi:10.1111/bjh.15661

Cited by 122 publications

(124 citation statements)

References 108 publications

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“…Third, corticosteroids should be used with caution before the diagnosis of central nervous system diseases because in patients with PCNSL, corticosteroid therapy may inhibit tumor growth or even cause the tumor to subside, thus affecting the accuracy of the biopsy. 7 Usually, a diagnosis should be obtained before any kind of treatment is administered. In our patient, histopathological interpretation was difficult because dexamethasone treatment resulted in tumor tissue necrosis, and accurate histopathological diagnosis took 2 weeks in this case.…”

Section: Discussionmentioning

confidence: 99%

A case report of primary central nervous system lymphoma

Lü

et al. 2020

J Int Med Res

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Most patients with primary central system lymphoma (PCNSL) have immune dysfunction. PCNSL without immune dysfunction is rare and extremely challenging to diagnose. Here, we report the case of a 52-year-old woman without immune dysfunction who presented with PCNSL. The patient died a few months after diagnosis and during treatment. A review of this PCNSL patient’s case highlighted that poor interpretation of imaging features and the poor correlation of laboratory test results with clinical findings led to a difficulty in making a diagnosis and administering the best treatment. For an accurate diagnosis of early stage PCNSL, positron-emission tomography computed tomography and corticosteroids should be used cautiously before stereotactic biopsy.

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Section: Discussionmentioning

confidence: 99%

A case report of primary central nervous system lymphoma

Lü

et al. 2020

J Int Med Res

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“…As mentioned, confirmation with tissue biopsy is the gold standard for diagnosis of and treatment planning for primary CNS lymphoma. 14,15 Others have reviewed serial CSF examinations in diagnosing hematological disease, but have found the addition of repeated CSF flow cytometry in succession is of low yield. 16 In this study, 477/613 patients had 2 CSF examinations and 136/613 patients had 3 or greater CSF examinations.…”

Section: Discussionmentioning

confidence: 99%

Cerebrospinal Fluid Flow Cytometry: Utility in Central Nervous System Lymphoma Diagnosis

Latonas

Shameli

et al. 2020

Can. J. Neurol. Sci.

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ABSTRACT:Background:Flow cytometry of the cerebrospinal fluid (CSF) is used in isolation or as an adjunct to cytology to increase the sensitivity of detecting central nervous system (CNS) lymphoma. We aimed to evaluate the sensitivity of CSF flow cytometry as a diagnostic screening tool for primary CNS lymphoma in patients presenting with undifferentiated neurologic symptoms.Methods:We retrospectively reviewed all CSF samples received by the Calgary Laboratory Services Flow Cytometry Laboratory from 2012 to 2015. Clinical data, laboratory investigations, radiologic imaging studies, and pathological data were analyzed. Clinical review extended to 2 years post-CSF flow cytometric testing.Results:Only 43/763 (5.6%) samples of CSF flow cytometry in 28/573 (4.9%) patients were found to be positive for a hematological malignancy in patients with undifferentiated neurologic symptoms. The overall sensitivity of the test was 13.8% with 25 patients with negative CSF flow cytometry later having a positive biopsy for CNS lymphoma. CSF flow cytometry was negative in all cases when at the time of CSF examination the patient did not have a previous hematological malignancy or findings of abnormal enhancement on MRI (n = 249).Conclusion:CSF flow cytometry has low utility in screening for primary CNS lymphoma in the absence of a previous history of hematologic malignancy or findings of abnormal enhancement on MRI.

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“…Serologic studies include testing for HIV, because PCNSL in immunosuppressed patients requires specific considerations and initiation of antiretroviral therapy, as well as for hepatitis B and C virus, because these may be reactivated in the context of therapy ( Figure 1). 10 Once the diagnosis is confirmed, treatment must begin expeditiously because PCNSL can progress rapidly. HD-MTX-based therapies (MTX dose of 3-8 g/m 2 ) are the standard for induction therapy in patients considered able to tolerate this therapy.…”

Section: Treatment Of Newly Diagnosed Pcnslmentioning

confidence: 99%

Challenges in the Treatment of Newly Diagnosed and Recurrent Primary Central Nervous System Lymphoma

Holdhoff

Mrugala

Grommes

et al. 2020

Journal of the National Comprehensive Cancer Network

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Primary central nervous system lymphomas (PCNSLs) are rare cancers of the central nervous system (CNS) and are predominantly diffuse large B-cell lymphomas of the activated B-cell (ABC) subtype. They typically present in the sixth and seventh decade of life, with the highest incidence among patients aged >75 years. Although many different regimens have demonstrated efficacy in newly diagnosed and relapsed or refractory PCNSL, there have been few randomized prospective trials, and most recommendations and treatment decisions are based on single-arm phase II trials or even retrospective studies. High-dose methotrexate (HD-MTX; 3–8 g/m2) is the backbone of preferred standard induction regimens. Various effective regimens with different toxicity profiles can be considered that combine other chemotherapies and/or rituximab with HD-MTX, but there is currently no consensus for a single preferred regimen. There is controversy about the role of various consolidation therapies for patients who respond to HD-MTX–based induction therapy. For patients with relapsed or refractory PCNSL who previously experienced response to HD-MTX, repeat treatment with HD-MTX–based therapy can be considered depending on the timing of recurrence. Other more novel and less toxic regimens have been developed that show efficacy in recurrent disease, including ibrutinib, or lenalidomide ± rituximab. There is uniform agreement to delay or avoid whole-brain radiation therapy due to concerns for significant neurotoxicity if a reasonable systemic treatment option exists. This article aims to provide a clinically practical approach to PCNSL, including special considerations for older patients and those with impaired renal function. The benefits and risks of HD-MTX or high-dose chemotherapy with autologous stem cell transplantation versus other, better tolerated strategies are also discussed. In all settings, the preferred treatment is always enrollment in a clinical trial if one is available.

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Guidelines for the diagnosis and management of primary central nervous system diffuse large B‐cell lymphoma

Cited by 122 publications

References 108 publications

A case report of primary central nervous system lymphoma

A case report of primary central nervous system lymphoma

Cerebrospinal Fluid Flow Cytometry: Utility in Central Nervous System Lymphoma Diagnosis

Challenges in the Treatment of Newly Diagnosed and Recurrent Primary Central Nervous System Lymphoma

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