Summary Statement on Primary Central Nervous System Lymphomas From the Eighth International Conference on Malignant Lymphoma, Lugano, Switzerland, June 12 to 15, 2002

Abstract

Under the sponsorship of the International Extranodal Lymphoma Study Group, a Multidisciplinary Workshop on primary CNS lymphoma (PCNSL) with over 50 participants from Europe, North America, Israel, and Australia was held as part of the Eighth International Conference on Malignant Lymphoma in Lugano, Switzerland (June 12 to 15, 2002). The main purposes of the Workshop were to exchange the latest scientific information, to analyze methodologic issues in the design of clinical trials, to reach a consensus on treatment recommendations and prognostic factors, to discuss clinical and molecular targets for future studies, and to establish an international collaborative group to conduct laboratory and clinical investigations in PCNSL. This article summarizes the contents of the Workshop, analyzes the current knowledge on the most relevant biologic and clinical issues in PCNSL, and focuses on fundamental challenges to be addressed in future studies.

Temozolomide as salvage treatment in primary brain lymphomas

“…We conclude that temozolomide is active in recurrent primary brain lymphomas and should further be evaluated in this disease, perhaps in combination with MTX as initial treatment. There is general consensus that high-dose methotrexate (HD-MTX) is the cornerstone of the initial treatment of primary central nervous system lymphomas (PCNSL) (Reni et al, 1997;Ferreri et al, 2000Ferreri et al, , 2002Ferreri et al, , 2003Reni and Ferreri, 2004a). However, for most patients, this remains an incurable disease, and attempts to improve survival with combinations of HD-MTX and other chemotherapeutic agents have not convincingly been shown to be superior to MTX alone (Ferreri et al, 2002;Ferreri et al, 2003).…”

“…However, for most patients, this remains an incurable disease, and attempts to improve survival with combinations of HD-MTX and other chemotherapeutic agents have not convincingly been shown to be superior to MTX alone (Ferreri et al, 2002;Ferreri et al, 2003). Although a recent retrospective analysis has suggested that the addition of cytarabine to HD-MTX might be an independent positive prognostic factor for improved survival (Ferreri et al, 2002), this observation has not been confirmed in a randomised phase III trial, in part because of the difficulties associated with conducting large prospective studies in such a rare disease. There are few agents with demonstrable activity in primary brain lymphoma.…”

“…There are few agents with demonstrable activity in primary brain lymphoma. Most active agents used for extracerebral nonHodgkin's lymphomas do not penetrate the blood -brain barrier at sufficient concentration to be effective against primary brain lymphoma, and agents that do penetrate the CNS have generally not been very effective, or have caused unacceptable toxicities (Ferreri et al, 2003;Reni and Ferreri, 2004a). As salvage therapy improves survival in PCNSL (Reni et al, 1999), we have chosen to prospectively evaluate new drugs in patients with relapsed or refractory disease in an attempt to identify promising agents with activity in primary brain lymphoma.…”

“…There is general consensus that high-dose methotrexate (HD-MTX) is the cornerstone of the initial treatment of primary central nervous system lymphomas (PCNSL) (Reni et al, 1997;Ferreri et al, 2000Ferreri et al, , 2002Ferreri et al, , 2003Reni and Ferreri, 2004a). However, for most patients, this remains an incurable disease, and attempts to improve survival with combinations of HD-MTX and other chemotherapeutic agents have not convincingly been shown to be superior to MTX alone (Ferreri et al, 2002;Ferreri et al, 2003). Although a recent retrospective analysis has suggested that the addition of cytarabine to HD-MTX might be an independent positive prognostic factor for improved survival (Ferreri et al, 2002), this observation has not been confirmed in a randomised phase III trial, in part because of the difficulties associated with conducting large prospective studies in such a rare disease.…”

Incidence, clinical features, treatment and outcome of primary central nervous system lymphoma in Norway A ten-year national survey

“…The disadvantage of this combination is the well-documented long-term treatmentinduced neurotoxicity, especially affecting the age group of over 60 (16,18). Chemotherapy alone has a well-documented effect on PCNSL and seems to cause less neurotoxic sequelae than the combination of radio-and chemotherapy, perhaps at the cost of a little decreased median survival (19,20).…”