Primary CNS lymphoma at first relapse/progression: characteristics, management, and outcome of 256 patients from the French LOC network

Abstract

About a third of PCNSL patients are primary refractory to first line treatment. We identified several independent prognostic factors that can guide the management of R/R PCNSL patients.

PD-1 blockade with nivolumab in relapsed/refractory primary central nervous system and testicular lymphoma

“…[1][2][3][4][5] PCNSLs arise from the brain, spinal cord, leptomeninges, or eye in the absence of prior or concurrent systemic disease. The median overall survival of patients with PCNSL is 30 to 50 months, with recurrence rates of almost 50% within the first 2 years of diagnosis.…”

“…The median overall survival of patients with PCNSL is 30 to 50 months, with recurrence rates of almost 50% within the first 2 years of diagnosis. 1,3 Additionally, one-third of patients with PCNSL are refractory to initial treatment. 2,3 Treatment options for relapsed/refractory PCNSL include whole-brain radiotherapy (WBRT) or high-dose chemotherapy and autologous stem cell transplantation in younger patients who did not receive these as a part of initial treatment, or conventional chemotherapy.…”

The challenge of adequate imaging surveillance in primary central nervous system lymphoma

“…2 The clinical usefulness of regular MRI at follow-up has been supported by a recent retrospective study of 256 PCNSL patients with relapsed or refractory disease. 3 This analysis identified asymptomatic versus symptomatic relapse/progression as a favorable prognostic factor and therefore suggests that early detection of relapse by MRI at regular follow-up may benefit asymptomatic patients, at least if salvage treatment is considered. 3 Early detection of tumor recurrence in patients with good clinical performance and no need of steroid treatment for symptom relief constitute better preconditions for application of potentially aggressive salvage regimens.…”

“…3 This analysis identified asymptomatic versus symptomatic relapse/progression as a favorable prognostic factor and therefore suggests that early detection of relapse by MRI at regular follow-up may benefit asymptomatic patients, at least if salvage treatment is considered. 3 Early detection of tumor recurrence in patients with good clinical performance and no need of steroid treatment for symptom relief constitute better preconditions for application of potentially aggressive salvage regimens. Younger patients amenable to high-dose chemotherapy with autologous stem cell transplantation (HDAST) for salvage treatment carry the best prognosis.…”

“…Younger patients amenable to high-dose chemotherapy with autologous stem cell transplantation (HDAST) for salvage treatment carry the best prognosis. 3 In patients who do not qualify for more aggressive regimens, rituximab, temozolomide, topotecan, and other agents may be considered. 4 In this issue Tabouret and coworkers 5 report on neuroimaging findings in 85 patients who had been enrolled in a prospective clinical trial for elderly patients with PCNSL.…”