Management of secondary central nervous system lymphoma

Abstract

CNS lymphoma (CNSL) is associated with inferior outcomes, which may be attributed to several factors: poor CNS penetrance of chemotherapeutics, including RCHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, prednisolone), 1 impaired neurocognitive function and patient performance status (PS) contributing to increased treatment toxicity, 2,3 and recurrent genetic aberrations conferring treatment resistance. [4][5][6] The rarity and heterogeneity of SCNSL also limits the evidence base for treatment recommendations, with poor outcomes potentially attributable at least in part to lack of optimised treatment protocols.This good practice paper focuses on diffuse large B-cell lymphoma (DLBCL), the most common SCNSL subtype. It covers diagnostic and therapeutic aspects of care for the three SCNSL scenarios and multiply relapsed SCNSL. Treatment recommendations are framed by patient fitness and treatment intent.

Treatment Strategies and Prognostic Factors in Secondary Central Nervous System Lymphoma: A Multicenter Study of 124 Patients

“…While significant progress has been made in the treatment of PCNSL including advanced clinical studies with an increasing role of HDT‐ASCT, prospective trials for SCNSL are limited and optimal management has not been defined yet. Recently, position articles on SCNSL management have been published 18 , 21 . Hence, we conducted this retrospective real‐world study of prognostic factors and long‐term outcome in 124 SCNSL patients intensively treated in curative intention at 5 hematologic departments.…”

Relapsed isolated CNS lymphoma treated with radiotherapy and intrathecal methotrexate followed by high‐dose intravenous methotrexate, rituximab, and temozolomide: A case report

“…In fact, the BSH good practice paper recommends that patients with RI‐SCNSL should be considered for enrolment in clinical trials, if such trials are available 9 . In cases where clinical trials are not accessible, it is advised to assess whether patients are suitable candidates for MATRix and ASCT treatments 9 . On the other hand, ESMO guidelines and guideline from combined three major national cancer societies in Pakistan (Society of Medical Oncology Pakistan, Pakistan Society of Haematology, and Pakistan Society of Clinical Oncology) do not mention treatments for secondary lymphoma 17,29,30 .…”

“…Importantly, some patients undergo relapse after treatment and the relapse may present with CNS involvement only. These secondary CNS lymphoma patients are classified as relapsed isolated CNS lymphoma (RI‐SCNSL) based on British Society for Haematology (BSH) good practice paper 9 . Other terminologies from BSH include synchronous CNS and systemic lymphoma at initial presentation (treatment‐naïve; TN‐SCNSL) and relapsed concomitant systemic and CNS disease following treatment for systemic lymphoma (RC‐SCNSL).…”

The management of newly diagnosed large B‐cell lymphoma: A British Society for Haematology Guideline

“…Primary extra-nodal LBCL is discussed in this guideline, with the exception of lymphoma involving the central nervous system, covered by separate BSH guideline publications. 1,2 Post-transplant lymphoproliferative disorders are also covered by a separate guideline. 3 The investigation and management of primary mediastinal large B-cell lymphoma, mediastinal grey-zone lymphoma, primary cutaneous LBCL, primary effusion lymphoma, plasmablastic lymphoma and Burkitt lymphoma are also beyond the scope of this guideline.…”

“…This BSH guideline summarises the recommended initial investigation and first‐line management of large B‐cell lymphoma (LBCL). Primary extra‐nodal LBCL is discussed in this guideline, with the exception of lymphoma involving the central nervous system, covered by separate BSH guideline publications 1,2 . Post‐transplant lymphoproliferative disorders are also covered by a separate guideline 3 .…”