Prognostic impact of meningeal dissemination in primary CNS lymphoma (PCNSL): experience from the G-PCNSL-SG1 trial

Korfel, Agnieszka; Weller, Michael; Martus, Peter; Roth, Patrick; Klasen, H. A.; Roeth, Alexander; Rauch, Michael; Hertenstein, Bernd; Fischer, Thomas; Hundsberger, Thomas; Leithäuser, Malte; Birnbaum, Tobias; Kirchen, Heinz; Mergenthaler, H.-G.; Schubert, Jöerg; Berdel, Wolfgang E.; Birkmann, Josef; Hummel, Michael; Thiel, Eckhard; Fischer, Lars

doi:10.1093/annonc/mdr627

Cited by 55 publications

(33 citation statements)

References 28 publications

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“…The combination of CSF analysis and neuroimaging detects meningeal involvement in 7% to 42% of patients. 2,3 Interestingly, the leptomeningeal involvement does not appear to be prognostic, with median overall survival ranging from 14 to 60 months depending on treatment response. 3,4 However, primary leptomeningeal lymphoma (PLML) without synchronous parenchymal brain/spine or systemic disease is rare.…”

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confidence: 99%

Primary leptomeningeal lymphoma

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confidence: 99%

Primary leptomeningeal lymphoma

et al. 2013

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“…Die Sensitivität und Spezifität der in der Routine verwendeten Parameter wie Zytomorphologie oder Gesamteiweißkonzentration sind jedoch unzureichend und nur in seltenen Fällen hilfreich bei der Diagnosestellung [2]. Ein vielversprechender Lymphommarker im Liquor scheinen den ersten Studien zufolge Mikro-RNA-Moleküle (miRNA) zu sein, kleine regulatorische RNA-Moleküle, die über eine Bindung an das 3'-Ende von mRNA-Transkripten die Genexpression regulieren.…”

Section: Neue Diagnostische Methoden Im Liquorunclassified

Primäre ZNS-Lymphome

Korfel

Schlegel

2015

Nervenarzt

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“…The presence of lymphoma cells in the CSF is probably not a negative prognostic marker [58]. Still, appropriate treatment of the CSF may be a prerequisite for long-lasting remissions.…”

Section: Intrathecal Therapymentioning

confidence: 99%

Treatment of Primary CNS Lymphoma

Roth

Stupp

Eisele

2013

Curr Treat Options Neurol

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OPINION STATEMENT: Primary central nervous system lymphoma is a particular challenge in clinical neuro-oncology. In contrast to most other malignant brain tumors, it may be considered a curable disease at least in younger patients who can tolerate intensive treatment regimens. Yet, therapeutic progress has been limited with little measurable improvement in outcome over the last two decades, mainly due to the low incidence of this tumor, which impedes the execution of large randomized clinical trials, and the failure of most large cooperative groups to conduct such trials. Whenever possible, high-dose methotrexate (HD-MTX) is the backbone of the therapeutic regimen. Response rates can be increased by the addition of second agents like ifosfamide or cytarabine, however, their impact on overall survival is less clear. Similarly, the use of the anti-CD20 antibody rituximab, commonly used in the treatment of B cell lymphomas outside the CNS, remains controversial and has not been examined in adequate clinical trials. The prognosis of patients, who do not qualify for HD-MTX-based chemotherapy, is considerably poorer. Radiation therapy is an active treatment with high response rates but does typically not result in long-lasting remissions. It remains an important therapeutic option as a salvage therapy in patients progressing on or no longer responding to HD-MTX-based treatment. The combination of HD-MTX and radiation therapy does not prolong overall survival. It is associated with significant neurotoxicity, and it should be avoided. Another matter of debate is whether consolidation therapy by other means, such as high-dose chemotherapy followed by stem cell support, is the most promising regimen. Given these numerous uncertainties, neuro-oncologists should strive for a treatment of PCNSL patients within clinical trials to allow for the development of improved therapeutic regimens. therapy does not prolong overall survival, is associated with significant (neuro-)toxicity and should be avoided. Whether consolidation therapy by other means such as highdose chemotherapy followed by stem cell support is the most promising regimen, is another matter of debate. Given these numerous uncertainties, neuro-oncologists should strive for a treatment of PCNSL patients within clinical trials to allow for the development of improved therapeutic regimens.

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Prognostic impact of meningeal dissemination in primary CNS lymphoma (PCNSL): experience from the G-PCNSL-SG1 trial

Cited by 55 publications

References 28 publications

Primary leptomeningeal lymphoma

Primary leptomeningeal lymphoma

Primäre ZNS-Lymphome

Treatment of Primary CNS Lymphoma

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