Contemporary conceptions of etiology, pathogenesis, management and treatment of primary diffuse large b-cell central nervous system lymphoma

• Main Authors: S. V. Voloshin, Yu. A. Krivolapov, A. V. Shmidt, V. A. Shuvaev, M. S. Fominykh, K. M. Abdulkadyrov
• Format: Article
• Language: Russian
• Published: ABV-press 2014-07-01
• Series: Onkogematologiâ
• Subjects: primary central nervous system diffuse large b-cell lymphoma; risk-adapted treatment; rituximab; methotrexate; intrathecal administration
• Online Access: https://oncohematology.abvpress.ru/ongm/article/view/29

In this article we present the most up-to-date information about etiology, pathogenesis, diagnostic and treatment principles of primary central nervous system diffuse large B-cell lymphoma. We propose algorithm of diagnosis and treatment based on literature review and own experience. The main methods for diagnosis verification are magneto-resonance tomography and stereotactic biopsy of mass with subsequent histological examination including immune staining. The common first-line therapy regimen is high-dose methotrexate therapy. However long-term prognosis still remains poor. Adverse prognostic factors for therapy response are age > 60 years, multifocal lesions, neurologic symptoms,previous treated disease. Considerable part of patient have contraindications or high-risk of adverse events for high-dose chemotherapy treatment. Anti-CD20 monoclonal antibody has no neurological toxicity with intravenous and intrathecal administrations. Combination therapy with reduced dose methotrexate and monoclonal antibody can be a reasonable treatment alternative for old and disable persons. The further survival improvement would be achieved by patient stratification and using of risk-adapted treatment algorithm.