Onkológia 3/2019
Prophylaxis and treatment of lymphomatous central nervous system infiltration
The article addresses CNS involvement in systemic lymphomas. Patients with the aggressive lymphomas are at high-risk. The treatment protocols for Burkitt’s and lymphoblastic lymhoma include effective procedures. Effective CNS prohylaxis strategies in mantle cell lymphoma are not known. For R-CHOP treated patients with diffuse large B-cell lymphoma (DLBCL) several factors and patients subgroups have been identified to be associated with high risk of CNS relapse: patients with high-risk CNS-IPI, involvement of testis, uterus, kidney, adrenal glands and possibly bone marrow, breast and epidural region, double-hit, triple-hit lymphoma, double-expressor lymphoma, more than two extranodal sites by positron emission tomography/computer tomography, serum lactate dehydrogenase level more than triple upper level of normal. Patients with anaplastic large cell lymphoma, ALK positive with more than one extranodal sites have been identified as peripheral T-cell lymphoma (PTCL) with high risk of CNS relapse. In patients with DLBCL and PTCL, two to four cycles of systemic methotrexate at dose of at least 3g/m2 are effective and prophylaxis of choice. Concurrent administration is preffered compared with the MTX administration post-completion of the intended cycles of R-CHOP. High-dose methotrexate after the other chemotherapy, usually R-CHOP, is recommended in case of limited stage primary testicular DLBCL. On the contrary, intrathecal chemoprophylaxis with methotrexate +/- cytarabine has been shown neither effective nor unequivocally ineffective in preventing of parenchymal CNS relapses and may be alternative if systemic MTX is contraindicated. Poor outcome in patients with CNS involvement by the aggressive lymphomas has been shown to be improved by treatment based on the high-dose methotrexate, usually in combination with other drugs penetrating the CNS parenchyma. Consolidation with high-dose chemotherapy and autologous stem cell transplantation seems to improve outcome. Regimen GMALL B-ALL/NHL 2002 is effective for DLBCL only in the first line treatment. Key words: malignant lymphoma, central nervous system involvement, risk factors, chemoprophylaxis,
Keywords: malignant lymphoma, central nervous system involvement, risk factors, chemoprophylaxis, treatment
