ما هو العلاج الخطي الأول لليمفوما الأولية للجهاز العصبي المركزي؟

References

DOI: 10.1093/neuonc/noac196

• HD-MTX is the drug of choice in PCNSL and chemotherapy should include MTX at HD (≥3 g/m2) both to cross the BBB and yield cytotoxic levels in the CSF.
• Chemotherapeutic agents to combine with HD MTX should be selected among active drugs known to cross the blood-brain-barrier, such as HD cytarabine and combinations used in large and/or randomized prospective trials have to be preferred (Level B).
• Most combinations addressed in large clinical trials include HD-MTX associated with an alkylating agent (procarbazine, carmustine, temozolomide, and thiotepa) (Level B).
• Patients receiving the most intensive induction regimen, consisting of HD-MTX, Ara-C, rituximab, and thiotepa (the MATRix regimen), showed a significantly higher CR rate (49%) in comparison to 23% in the least intensive regimen, consisting of HD-MTX and Ara-C, (P = .0007) with a 2-year OS of 69% and 42% respectively.