Intrathecal chemotherapy in lymphomatous meningitis

Canova, Fabio; Marino, Dario; Trentin, Chiara; Soldà, Caterina; Ghiotto, Cristina; Aversa, Savina

doi:10.1016/j.critrevonc.2010.07.005

Cited by 13 publications

(16 citation statements)

References 81 publications

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“…In patients that received solid organ transplants and developed primary CNS-PTLD rituximab either at standard doses or higher doses has been used with some success [5,29]. In addition, rituximab as a single agent as well as in combination with cytotoxic chemotherapy, has been employed in the treatment of primary CNS lymphoma [20,[30][31][32][33][34] and intra-ventricular rituximab has been used in patients with lymphomatous meningitis [35][36][37].…”

Section: Discussionmentioning

confidence: 99%

Primary central nervous system post-transplant lymphoproliferative disorders following allogeneic hematopoietic stem cell transplantation

et al. 2011

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Post-transplant lymphoproliferative disorder (PTLD) is a serious complication after allogeneic hematopoietic stem cell transplantation (HSCT). Extra nodal involvement is common in PTLD, but isolated involvement of the central nervous system (CNS) is extremely rare. Given the rarity of primary CNS-PTLD there is no consensus on optimal treatment. We report a patient who developed Epstein-Barr virus related primary CNS-PTLD following allogeneic HSCT who was treated with the monoclonal anti-CD20 antibody rituximab and reduction of immunosuppression. In addition, we review the literature and discuss treatment options for patients with primary CNS-PTLD following allogeneic HSCT.

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Section: Discussionmentioning

confidence: 99%

Primary central nervous system post-transplant lymphoproliferative disorders following allogeneic hematopoietic stem cell transplantation

et al. 2011

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“…Reduction of immunosuppression to restore host immune competence is the first-line treatment of choice in nonaggressive disease, with rituximab-based chemotherapy for all other cases [137]. Intraventricular rituximab injection has been used in patients with lymphomatous meningitis [138]. Response rates are quite encouraging, but incomplete T cell immune recovery determines a high risk of disease recurrence [139].…”

Section: Post-transplantation Lymphoproliferative Disorders and Diseamentioning

confidence: 99%

Neurologic Complications after Allogeneic Hematopoietic Stem Cell Transplantation

Madon

Festuccia

Brunello

et al. 2017

Biology of Blood and Marrow Transplantation

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Neurologic complications after hematopoietic stem cell transplantation are frequently life-threatening, and their clinical management can be highly challenging. A wide spectrum of causative factors-including drug-related toxicities; infections sustained by virus, bacteria, or invasive molds; metabolic encephalopathy; cerebrovascular disorders; immune-mediated disorders; and disease recurrence-may lead to potentially lethal complications. Moreover, given that some neurologic complications are not uncommonly diagnosed post mortem, their overall incidence is likely to be underestimated. Their prompt recognition and timely treatment are of paramount importance to reduce the risk for transplantation-related death.

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“…However, using the intra-cerebro-spinal fluid (ICSF) route of administration for drug delivery to the brain has proven successful in other conditions where CNS tissue penetration is less critical, such as meningeal carcinomatosis, spasticity, chronic pain, and lymphomatous meningitis. Intrathecal baclofen is used to treat spasticity (152), intrathecal opioids are used to treat chronic pain (153), and intrathecal chemotherapy for meningeal carcinomatosis (154) and lymphoma (155). Importantly, in most cases, the intrathecal/intraventricular approach has delivered the drugs close to ventricular surfaces.…”

Section: Examples and Opportunities For New Therapeutic Strategiesmentioning

confidence: 99%

“…The 150 ml average volume of CSF in the human CNS is completely turned over every 6–8 h, and exits the brain mainly into the blood. Moreover, ICSF drug delivery to the brain results in high drug exposure at the ependymal surface of the brain, which can cause a subependymal inflammatory reaction and tissue damage (155). A paradox of ICSF drug administration is that in many cases, the drug distributes to the blood much better than it does to the brain due to this rapid circulation and clearance pathway (10).…”

Section: Examples and Opportunities For New Therapeutic Strategiesmentioning

confidence: 99%

Emerging Insights into Barriers to Effective Brain Tumor Therapeutics

Dunn²,

et al. 2014

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There is great promise that ongoing advances in the delivery of therapeutics to the central nervous system (CNS) combined with rapidly expanding knowledge of brain tumor patho-biology will provide new, more effective therapies. Brain tumors that form from brain cells, as opposed to those that come from other parts of the body, rarely metastasize outside of the CNS. Instead, the tumor cells invade deep into the brain itself, causing disruption in brain circuits, blood vessel and blood flow changes, and tissue swelling. Patients with the most common and deadly form, glioblastoma (GBM) rarely live more than 2 years even with the most aggressive treatments and often with devastating neurological consequences. Current treatments include maximal safe surgical removal or biopsy followed by radiation and chemotherapy to address the residual tumor mass and invading tumor cells. However, delivering effective and sustained treatments to these invading cells without damaging healthy brain tissue is a major challenge and focus of the emerging fields of nanomedicine and viral and cell-based therapies. New treatment strategies, particularly those directed against the invasive component of this devastating CNS disease, are sorely needed. In this review, we (1) discuss the history and evolution of treatments for GBM, (2) define and explore three critical barriers to improving therapeutic delivery to invasive brain tumors, specifically, the neuro-vascular unit as it relates to the blood brain barrier, the extra-cellular space in regard to the brain penetration barrier, and the tumor genetic heterogeneity and instability in association with the treatment efficacy barrier, and (3) identify promising new therapeutic delivery approaches that have the potential to address these barriers and create sustained, meaningful efficacy against GBM.

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Intrathecal chemotherapy in lymphomatous meningitis

Cited by 13 publications

References 81 publications

Primary central nervous system post-transplant lymphoproliferative disorders following allogeneic hematopoietic stem cell transplantation

Primary central nervous system post-transplant lymphoproliferative disorders following allogeneic hematopoietic stem cell transplantation

Neurologic Complications after Allogeneic Hematopoietic Stem Cell Transplantation

Emerging Insights into Barriers to Effective Brain Tumor Therapeutics

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