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Primary central nervous system lymphomas.

Julette F Batara1, Stuart A Grossman

  • 1Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD 21231, USA.

Current Opinion in Neurology
|November 19, 2003
PubMed
Summary
This summary is machine-generated.

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Primary central nervous system lymphoma (PCNSL) incidence is rising in older adults. High-dose methotrexate-based regimens have improved PCNSL survival rates and reduced neurotoxicity compared to radiation.

Area of Science:

  • Neuro-oncology
  • Hematology
  • Immunology

Background:

  • Primary central nervous system lymphoma (PCNSL) is an aggressive B-cell malignancy affecting the brain and eyes.
  • It occurs in both immunocompetent and immunosuppressed individuals, with increasing incidence in those over 60.
  • Primary ocular lymphoma is a significant subtype of PCNSL.

Purpose of the Study:

  • To review recent advancements, ongoing investigations, and current controversies in managing PCNSL.
  • To highlight the evolving treatment landscape and its impact on patient outcomes.
  • To discuss the changing incidence patterns of PCNSL.

Main Methods:

  • Literature review of recent studies on PCNSL management.
  • Analysis of treatment shifts from cranial irradiation to methotrexate-based chemotherapy.

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  • Examination of survival data and neurotoxicity profiles.

    • Main Results:

    • PCNSL incidence is rising in immunocompetent individuals over 60.
    • AIDS-related PCNSL incidence has decreased due to effective antiretroviral therapy.
    • High-dose methotrexate-based regimens have increased median survival from 1 to over 3 years, with reduced neurotoxicity.
    • Careful management of opportunistic infections, thromboembolic events, and renal toxicity is crucial with methotrexate.

    Conclusions:

    • PCNSL frequency is increasing, and therapeutic outcomes have significantly improved.
    • Key unanswered questions include optimal methotrexate dosing, duration, and the role of other therapies like intrathecal treatment and radiation.
    • Further progress necessitates participation in well-designed multicenter clinical trials.