Relapsed Primary Central Nervous System Lymphoma: Current Advances

Abstract

Primary central nervous system lymphoma is an invasive malignant lymphoma confined to the central nervous system. Although patients undergoing first-line treatment can achieve complete response, most of them still relapse within two years. Relapsed lymphoma is derived from occult lymphoma cells, and B cell receptor pathway activation and immune escape are the key mechanisms for the pathogenesis of PCNSL. Most relapses are in the central nervous system, a small number of relapses are isolated systemic relapses, and clinical symptoms occur early and vary. Current treatments for relapse include high-dose methotrexate rechallenge and other regimens of chemotherapy, whole-brain radiation therapy, hematopoietic stem-cell transplantation, targeted therapy and immunotherapy, which have become promising treatments. The overall prognosis of relapsed PCNSL is very poor, although it is affected by many factors. This article summarizes the mechanisms, related factors, clinical features, follow-up, treatment and prognosis of relapsed primary central nervous system lymphoma.

Use of rituximab, temozolomide, and radiation in recurrent and refractory primary central nervous system lymphoma in the Philippines: a retrospective analysis

“… 21 Rituximab is a CD20-targeted monoclonal antibody that induces apoptosis, causes cytotoxicity via antigen-dependent cell-mediated and complement-mediated pathways, and downregulation of IL-10 transcription, resulting in downstream inactivation of STAT3 and reduced expression of the anti-apoptotic gene Bcl-2. 22 , 23 It is through the latter mechanism that rituximab plays a role in the sensitization of CD20 + B lymphoma cells to cytotoxic chemotherapy, which makes it useful in combination with other regimens on top of its tolerability. 9 , 24 On the other hand, temozolomide is a well-tolerated alkylating agent, whose active form MTIC (5-(3-methyl-1-triazene) imidazole-4-carboxamide) binds to purine sites on DNA, evidently resulting in cell death.…”

The Role of Pretherapeutic Diffusion-Weighted MR Imaging Derived Apparent Diffusion Coefficient in Predicting Clinical Outcomes in Immunocompetent Patients with Primary CNS Lymphoma: A Systematic Review and Meta-Analysis

“…Following chemotherapy, whole brain radiotherapy (WBRT) may be given, depending on the response to initial therapy (Hoang-Xuan et al, 2015). While chemotherapy and WBRT have been shown to be effective, the majority of patients continue to experience relapses within a short period of time, and the prognosis remains poor following treatment (Hoang-Xuan et al, 2015;Tao et al, 2021). WBRT, HD MTX, and the combination of multiple chemotherapeutic agents, on the other hand, can increase the risk of adverse events in patients (Hoang-Xuan et al, 2015).…”

Recurrent B‐Cell lymphoma in a lower limb reconstructive flap after trauma

“…PCNSL is a rare aggressive form of non‐Hodgkin's Lymphoma originating from the CNS or eyes, and accounts for 1–4% of CNS malignancies 1–3 . The most common subtype is diffuse large B‐Cell Lymphoma (DLBCL) 1–4 .…”

“…PCNSL is a rare aggressive form of non-Hodgkin's Lymphoma originating from the CNS or eyes, and accounts for 1-4% of CNS malignancies. [1][2][3] The most common subtype is diffuse large B-Cell Lymphoma (DLBCL). [1][2][3][4] Two-year recurrence rates of 36-66% are reported, with 85-90% of relapses occurring within the CNS.…”

“…[1][2][3] The most common subtype is diffuse large B-Cell Lymphoma (DLBCL). [1][2][3][4] Two-year recurrence rates of 36-66% are reported, with 85-90% of relapses occurring within the CNS. 1,3,5 Mechanisms of extra-cranial relapse are unknown however hypotheses include microscopic tumour seeding, PCNL cell dissemination beyond the blood brain barrier or migration across invasive lines such as shunts.…”