علاج سرطان الغدد الليمفاوية الأولي للجهاز العصبي المركزي مع وظيفة كلوية كافية وكسر الطرد البطيني الأيسر >45%

References

DOI: 10.1016/j.annonc.2023.11.010

• Moreover, the use of high-dose (HD) methotrexate (MTX), the most important component of chemotherapy (ChT) regimens used as first-line treatment, requires suitable renal (creatinine clearance >50 ml/min), hepatic and cardiac (left ventricular ejection fraction >45%) functions.
• Accordingly, stratification between ‘young’ and ‘elderly’ patients should not be made considering exclusively the patient’s age but also the ability to tolerate intensified treatments, informed by performance status (PS), organ function, comorbidities and frailty.
• When a prospective trial is not available, induction ChT including HD-MTX is recommended at a minimum dose of 3 g/m² delivered in a 3-h infusion.
• Combinations of HD-MTX with other cytotoxic agents that cross the blood–brain barrier and have been tested in prospective (preferably randomised) trials are recommended.
• Response to treatment should follow IPCG criteria: gadolinium-enhanced MRI of the brain should be carried out every two courses during induction ChT and 2 months after consolidation, and compared with baseline MRI, with the addition of ocular and CSF exams if involved at baseline.