Overall strategies for primary CNS lymphoma

During ASCO 2019 held in Chicago, US, Andres J. Ferreri, San Raffaele Hospital, Milan, IT, spoke to the Lymphoma Hub about the overall strategies for primary central nervous system (CNS) lymphoma.

Andres J. Ferrari discusses the optimal induction strategy of high-dose methotrexate with an alkylating agent and rituximab, though he notes that in patients who are unable to receive chemotherapy, primary radiation can be considered. He moves on to discuss the multiple consolidation strategies that are available including; observation, whole-brain radiotherapy, high-dose chemotherapy + autologous stem cell transplant, non-myeloablative chemotherapy, or new oral drugs. He summarizes two main challenges; treating chemo-refractory disease (some new phase II trials concluded lenalidomide and ibrutinib can be used in this setting) and the low penetration of blood-brain barrier (recent reports suggest that using an engineered tumor necrosis factor can increase this penetration).