Primary CNS lymphoma

Abstract

Primary central nervous system lymphoma (PCNSL), an uncommon tumor, is occurring with increasing frequency. Conventional therapy with corticosteroids and cranial radiotherapy (RT) usually gives a dramatic initial response, but median survival is only 10 to 18 months. Chemotherapy is more successful in comparable systemic lymphoma and has been employed for PCNSL at relapse, causing remission but not cure. Between June 1985 and June 1988, we prospectively staged 32 patients with PCNSL at Memorial Sloan-Kettering Cancer Center and treated 28 on a new protocol that combined chemotherapy and radiotherapy at diagnosis. None had occult systemic lymphoma, but 19% had ocular and 69% had definite or probable leptomeningeal lymphoma. There were no complications in 19 stereotactic biopsies, but 4/10 patients who had a complete resection suffered a severe postoperative deficit. Four patients received RT alone, and 28 received chemotherapy and cranial RT, 17 of whom (group A) received a combination regimen using pre-RT systemic (1 g/m2) and intra-Ommaya methotrexate (MTX), 4,000 cGy whole-brain RT with a 1,440 cGy boost, and 2 courses of post-RT high-dose cytosine arabinoside; 5 other patients received an identical regimen but with a decreased dose of MTX (200 mg/m2). Sixty-three percent of assessable patients had a response to MTX independent of corticosteroid and prior to RT. Eighteen of 26 (69%) assessable patients who received combined therapy are alive with a median follow-up of 25.4 months. Twelve of 16 (75%) assessable group A patients are alive in the same period. Chemotherapy-related toxicity was minimal, and no late toxicities have occurred to date.(ABSTRACT TRUNCATED AT 250 WORDS)

Treatment of Relapsed Central Nervous System Lymphoma with High-Dose Methotrexate

“…The introduction of high-dose methotrexate (HD-MTX) into the treatment of primary nervous system lymphoma has substantially improved the survival of patients with this disease (1)(2)(3). Between 50 and 65% of patients achieve a complete radiographic response after treatment with regimens containing HD-MTX, and an additional 20 to 35% of patients achieve a partial radiographic response (4 -7).…”

Multivariate analysis of prognostic factors in patients with non HIV-related primary cerebral lymphoma. A proposal for a prognostic scoring

“…In contrast to other non Hodgkin's lymphomas (Canellos et al, 1987;Coiffer et al, 1989;Longo et al, 1991;Patte et al, 1991), PCL has a poor prognosis in most of the series with treatment combining surgery with chemotherapy and/or radiotherapy (Murray et al, 1987;Hochberg & Miller, 1988;Berry et al, 1981;Letendre et al, 1982;Gonzales-Gonzales et al, 1983;Freeman et al, 1986). However, intensive chemotherapy regimens including drugs that pass the bloodbrain barrier appear to give improved results in recently published trials (De Angelis et al, 1990;Neuwelt et al, 1991;De Angelis et al, 1992). Neuwelt et al (1991) have described a regimen containing high dose methotrexate (HDMTX) and two alkylating agents given wtih osmotic blood-brain barrier disruption which yields a projected 40% survival and at 3 years.…”

Molecular pathology of primary intraocular lymphoma

“…97 Recent data suggest that prompt therapy can improve prognosis. 76 Since initiation of therapy requires an accurate diagnosis, it is essential to identify lymphoma cells in the eye. One of the elements to improve the yield of diagnosis is prompt and appropriate handling and processing of specimens, particularly vitreous specimens.…”

“…Currently, chemotherapy is recommended as the first treatment for all patients with PCNSL. 15,76,77 The best regimens include high-dose methotrexate (0.8 to 1.5 g/m 2 ) that can penetrate the blood-brain barrier and are associated with completeresponse rates of 50% to 80%. When methotrexate-based regimens are used prior to cranial radiation, the median survival is increased to at least 40 months.…”