Treatment Options for Recurrent Primary CNS Lymphoma

Area of Science:

• Neuro-oncology
• Hematology
• Clinical Therapeutics

Background:

• Primary CNS lymphoma (PCNSL) is a rare non-Hodgkin lymphoma variant.
• Limited prospective trials result in no consensus for refractory/relapsed (r/r) PCNSL treatment.
• Salvage therapy selection depends on patient factors and prior treatment response.

Purpose of the Study:

• To outline current strategies for managing r/r PCNSL.
• To highlight the role of high-dose methotrexate (HD-MTX) in salvage therapy.
• To discuss consolidation and emerging treatment options.

Main Methods:

• Retrospective analysis of treatment outcomes.
• Selection of salvage chemotherapy based on patient performance status and disease characteristics.
• Consideration of myeloablative chemotherapy with autologous stem cell transplant (ASCT) for eligible patients.
• Use of alternative agents (pemetrexed, temozolomide/rituximab, cytarabine) or WBRT for refractory disease or contraindications.

Main Results:

• HD-MTX-based regimens demonstrate high response rates in the relapsed setting.
• ASCT offers a potentially curative approach for suitable patients.
• Conventional chemotherapy or WBRT serve as consolidation options for non-transplant candidates.
• Emerging therapies like BTK inhibitors, immunomodulatory drugs, ICIs, and CAR-T cells are under investigation.

Conclusions:

• Salvage therapy for r/r PCNSL requires individualized approaches.
• HD-MTX remains a cornerstone for remission re-induction.
• ASCT is a key consideration for eligible patients.
• Novel agents and clinical trial participation are crucial for advancing r/r PCNSL management.