Recent developments and controversies in primary central nervous system lymphoma

Area of Science:

• Neuro-oncology
• Hematology
• Immunology

Background:

• Primary central nervous system lymphoma (PCNSL) is a rare malignancy with debated treatment strategies.
• Recent collaborative efforts have enabled randomized trials and genomic analyses in PCNSL.

Purpose of the Study:

• To review recent advancements in the management of PCNSL.
• To highlight new biological insights into PCNSL tumorigenesis.

Main Methods:

• Review of recent randomized trials and genomic studies.
• Analysis of data on treatment outcomes and biological pathways.

Main Results:

• Consolidation radiotherapy's role post-chemotherapy is questioned, particularly in elderly patients, to mitigate neurotoxicity.
• High-dose chemotherapy with autologous stem cell transplantation is supported as a therapeutic option.
• Rituximab addition to initial treatment shows promise.
• Activation of specific signaling pathways (BCR/TLR/NF-κB) presents potential therapeutic targets.

Conclusions:

• Evidence challenges the necessity of consolidation radiotherapy after methotrexate-based chemotherapy.
• Autologous stem cell transplantation is a viable intensive treatment option.
• Rituximab incorporation and targeting signaling pathways offer new therapeutic avenues for PCNSL.