Treatment of newly diagnosed B-cell origin primary CNS lymphoma with systemic R-IDARAM chemotherapy and intrathecal immunochemotherapy

Qian, Liren; Zhou, Chengyu; Shen, Jianliang; Cen, Jian; Yin, Wu

doi:10.18632/oncotarget.8370

Cited by 12 publications

(7 citation statements)

References 29 publications

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“…[ 14 15 16 17 ] Certain groups have modified the R-IDARAM protocol to improve the response rates. [ 18 19 ] Qian et al [ 20 ] used R-IDARAM protocol with additional intraventricular immunochemotherapy to provide therapeutic concentrations in the CNS and declared high rates of OS and PFS in a 3-year follow-up (84.2% and 63.2%, respectively). In this report, two patients of PCNSL and a patient of SCNSL have survived for 88, 79, and17 months, respectively, without disease progression in a median of 79-month follow-up.…”

Section: Discussionmentioning

confidence: 99%

R-IDARAM treatment in central nervous system lymphomas: A single-center experience and review of the literature

et al. 2020

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Introduction : Central nervous system lymphomas (CNSLs) require effective treatment strategies due to aggressive nature of disease. Despite therapeutic approaches having improved in the last decades, there is no standard treatment for these patients. As a CNSL targeted-therapy IDARAM protocol was developed, the outcomes were reported with a few studies. We observed the R-IDARAM protocol in our CNSL cases, and we discuss the effectiveness, tolerability, and toxicity with a review of the literature in this article. Subjects and Methods : We retrospectively analyzed response rates, progression-free survival, adverse events, and long-term side effects in patients who were treated by modified R-IDARAM as standard clinical care of CNSL in our hematology department. Results : Response was achieved in five of nine patients. Three patients (two primary CNSL and one secondary CNSL) are still being followed up without disease progression with a median duration of follow-up of 79 months (88, 79, and 17 months, respectively). Manageable hematological side effects including thrombocytopenia and neutropenia were experienced by all patients. Conclusion : R-IDARAM protocol may be an option with high early response rates and manageable toxicity. Hematological side effects are the main problem, and long-term neurological toxicity is not common. Eligible patients must continue with autologous stem cell transplantation due to poor long-term survival outcomes.

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Section: Discussionmentioning

confidence: 99%

R-IDARAM treatment in central nervous system lymphomas: A single-center experience and review of the literature

et al. 2020

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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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“…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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Treatment of newly diagnosed B-cell origin primary CNS lymphoma with systemic R-IDARAM chemotherapy and intrathecal immunochemotherapy

Cited by 12 publications

References 29 publications

R-IDARAM treatment in central nervous system lymphomas: A single-center experience and review of the literature

R-IDARAM treatment in central nervous system lymphomas: A single-center experience and review of the literature

Primary central nervous system lymphoma

Primary Central Nervous System Lymphoma

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