Objective cerebrospinal fluid response to intraventricular rituximab in indolent CNS lymphoma

Strowd, Roy E.; Abuali, Inas; Grossman, Stuart A.

doi:10.2217/cns.15.3

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…Intrathecal administration of rituximab alone or in combination with systemic chemotherapy is well tolerated and should be investigated in future trials of patients with PCNSL and leptomeningeal involvement. 63 , 64 …”

Section: Treatmentmentioning

confidence: 99%

Primary central nervous system lymphoma

Low

Han

Batchelor

2018

Ther Adv Neurol Disord

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Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal non-Hodgkin lymphoma (NHL), confined to the brain, eyes, spinal cord or leptomeninges without systemic involvement. Overall prognosis, diagnosis and management of PCNSL differ from other types of NHL. Prompt diagnosis and initiation of treatment are vital to improving clinical outcomes. PCNSL is responsive to radiation therapy, however whole-brain radiotherapy (WBRT) inadequately controls the disease when used alone and its delayed neurotoxicity causes neurocognitive impairment, especially in elderly patients. High-dose methotrexate (HD-MTX)-based induction chemotherapy with or without autologous stem cell transplantation (ASCT) or reduced-dose WBRT leads to durable disease control and less neurotoxicity. The optimal treatment has yet to be defined, however HD-MTX-based induction chemotherapy is considered standard for newly diagnosed PCNSL. Ongoing randomized trials address the role of rituximab, and of consolidative treatment using ASCT or reduced-dose WBRT. Despite high tumor response rates to initial treatment, many patients have relapsing disease with very poor prognosis. The optimal treatment for refractory or relapsed PCNSL is poorly defined. The choice of salvage treatment depends on age, previous treatment and response, performance status and comorbidities at the time of relapse. Novel therapeutics targeting underlying tumor biology include small molecule inhibitors of B-cell receptor, cereblon, and mammalian target of rapamycin signaling, and immunotherapy programmed cell death 1 receptor inhibitors and chimeric antigen receptor T cells.

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Section: Treatmentmentioning

confidence: 99%

Primary central nervous system lymphoma

Low

Han

Batchelor

2018

Ther Adv Neurol Disord

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“…37 Intrathecal administration of rituximab alone or in combination with systemic chemotherapy is well tolerated and should be investigated in future trials for patients with PCNSL and leptomeningeal involvement. 38,39 Consolidation Therapy…”

Section: Rituximabmentioning

confidence: 99%

Primary Central Nervous System Lymphoma

Low

Batchelor

2018

Semin Neurol

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Primary central nervous system lymphoma (PCNSL) is an extranodal non-Hodgkin lymphoma limited to the brain, spinal cord, leptomeninges, and eyes. The majority of patients are immunocompetent, with a median age of 65 years at diagnosis. Historically, whole-brain radiation therapy (WBRT) was the first and sole treatment for PCNSL. Today, due to the recognized neurotoxicity of WBRT, this modality is usually avoided in the treatment. Most chemotherapy regimens are based on high-dose methotrexate plus the anti-CD20 monoclonal antibody rituximab, leading to high response rates, but 5-year survival is still poor at approximately 30% compared with other extranodal lymphomas. New treatment strategies including high-dose chemotherapy/autologous stem cell transplantation, targeted therapies focusing on, for example, genetic alterations in B cells or mammalian target of rapamycin signaling, and immunotherapy with inhibitors of the programmed cell death 1 receptor are only a few options to improve the armamentarium against PCNSL.

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Characteristics and outcomes of non-Hodgkin’s lymphoma patients with leptomeningeal metastases

Meng

Fan

et al. 2018

Int J Clin Oncol

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BackgroundLeptomeningeal metastasis is an uncommon but devastating complication. The incidence of non-Hodgkin’s lymphoma has been increasing in recent decades, due to the poor central nervous system penetration of drugs and the prolonged overall survival of patients, leptomeningeal metastases has gradually increased over time. Patients with leptomeningeal metastases have short survival durations and poor quality of life; there are few studies about non-Hodgkin’s lymphoma with leptomeningeal metastases. We investigated characteristics and outcomes of non-Hodgkin’s lymphoma patients with leptomeningeal metastases.MethodsThis study included 27 non-Hodgkin’s lymphoma patients with leptomeningeal metastases diagnosed at Tianjin Medical University Cancer Institute and Hospital between 2013 and 2016. Statistical analysis was performed to investigate the overall survival of non-Hodgkin’s lymphoma with leptomeningeal metastases.ResultsDiffuse large B cell lymphoma was the most common cancer subtype (21/27, 78%), and more than half of the patients showed extranodal involvement (18/27, 67%). Survival analysis has shown extranodal involvement (P = 0.0205), International Prognostic Index (P = 0.0112), performance status (P < 0.0001), parenchymal involvement (P = 0.0330) and received radiotherapy (P = 0.0056) were predictive factors of prognosis for these patients with leptomeningeal metastases. Cox regression analysis has shown patients with concurrent parenchymal involvement and received radiotherapy are correlated with good prognosis.ConclusionsGiven the small number of patients who were included, this study exhibited limitations with respect to analytical power and the random selection of patients. Nevertheless, this investigation revealed characteristics of non-Hodgkin’s lymphoma patients with leptomeningeal metastases and suggested that such patients could benefit from multimodal therapy.Electronic supplementary materialThe online version of this article (10.1007/s10147-018-1268-5) contains supplementary material, which is available to authorized users.

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Objective cerebrospinal fluid response to intraventricular rituximab in indolent CNS lymphoma

Cited by 4 publications

References 14 publications

Primary central nervous system lymphoma

Primary central nervous system lymphoma

Primary Central Nervous System Lymphoma

Characteristics and outcomes of non-Hodgkin’s lymphoma patients with leptomeningeal metastases

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