A focus on pharmacotherapy for primary central nervous system lymphoma

The prognosis of primary central nervous system lymphoma (PCNSL) is still poor compared to other diffuse large B-cell lymphomas. High-dose methotrexate-based chemotherapy plays a central role in the management of PCNSL; however, the optimal regimen has not been established thus far. Consolidating whole-brain radiotherapy is currently not routinely being performed at most centers due to lack of survival advantage in a randomized Phase III trial and increased risk of cognitive impairment. Promising results with the combination of high-dose methotrexate-based chemotherapy with the CD20 antibody rituximab and consolidating the primary chemotherapy by other non-cross-resistant conventional chemotherapy or high-dose chemotherapy followed by autologous stem cell transplantation have been reported in non-comparative studies. Results of well-designed randomized trials must be awaited to better define the optimal management of PCNSL.