Chemotherapy for Primary Central Nervous System Lymphoma

Antonio M. P. Omuro, MD; Lauren E. Abrey, MD


Neurosurg Focus. 2006;21(5) 

In This Article


Despite the limitations and heterogeneity of available data, a few general conclusions can be drawn. Elderly patients have a worse prognosis overall, but these individuals clearly benefit from chemotherapy, and the risk associated with WBRT is not acceptable. Available studies of this group support the use of high-dose MTX in the range of 3 to 3.5 g/m2 in combination with other drugs. In younger patients, the goal is to increase the chance of cure while preserving cognitive function and quality of life. Chemotherapy-only regimens are associated with a short PFS time and a decreased potential for cure. Therefore, the available data support the use of WBRT for young patients treated with MTX-based regimens. The Bonn protocol may represent an attractive alternative to a chemotherapy-only approach in younger patients, but the mortality rate from toxicity is unacceptable. However, the Bonn study validates the concept that "more is better" for this young population. This provides a rationale for exploring the role of intensified first-line treatments such as HDC and ASCT as a replacement for WBRT. Planned or ongoing studies are also investigating the role of other approaches such as BBB disruption, immunotherapy, very high doses of MTX with subsequent glucarpidase rescue, and alternative drugs such as temozolomide and rituximab.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.
Post as: