DLBCL, PRIMARY AND SECONDARY CENTRAL NERVOUS SYSTEM INVOLVEMENT, TREATMENT AND PROPHYLAXIS, ACTA UNIVERSITATIS OULUENSIS D Medica 1436
|Kustantaja:||Oulun yliopisto|| |
|Painos:||Osajulkaisuväitöskirjan yhteenveto-osa|| |
|Sijainti:||Print Tietotalo|| |
|Tekijät:||KUITUNEN HANNE|| |
Diffuse large B-cell lymphoma (DLBCL) is the most common type of Non-Hodgkin´s Lymphoma
(NHL). The standard treatment for DLBCL is R-CHOP chemoimmunotherapy (rituximab,
cyclophosphamide, vincristine, doxorubicin and prednisone). About one -third of patients have
refractory disease or the lymphoma relapses. Prognosis after relapse of refractory disease is poor.
Fitter and younger patients are recommended new intensive salvage chemotherapy followed by
autologous stem cell transplantation. Central nervous system (CNS) relapse is the most feared
complication with dismal prognosis in DLBCL. High dose methotrexate intravenously
administered concurrently with R-CHOP treatment has shown to be most promising to prevent
Primary CNS lymphoma (PCNSL) is a rare aggressive lymphoma limited to the CNS and eyes.
PCNSL is a chemo-and radiosensitive disease, but long-term response is rare since the blood brain
barrier (BBB) limits access of many drugs to the CNS. BBB disruption (BBBD) is a treatment
modality where the BBB is opened by hypertonic mannitol infusion. Administration of
chemotherapeutics will achieve over ten-fold concentrations in the CNS and eradicate
microscopic disease involvement.
This study retrospectively analyses patients who treated as first line with Bonn/Bonn-like
treatment (study I), with BBBD treatment followed by high-dose treatment/autologous stem cell
transplantation (HDT/ASCT) in first- or second-line (study II) or those treated with primary RCHOP
or its derivatives with or without concurrent CNS-targeted treatment (study III).
HD-MTX-based multichemotherapy is an effective induction treatment in CNS lymphoma, but
long-lasting responses are rare. BBBD-treatment is well-tolerated and a promising method to
attain high drug concentrations in the CNS to eradicate microscopic disease involvement in firstand
second-line. CNS-prophylaxis with HD-MTX prevents CNS events in high risk DLBCL.
PCNSL is agressive disease despite excellent primary response with HD-MTX based
multichemotherapy. BBBD-treatment is a promising method to eradicate microscopic disease in
the CNS and achieve a long-term response and cure rate. Fatal CNS relapses can be avoided using