سرطان الغدد الليمفاوية الأولي للجهاز العصبي المركزي: التعزيز بعد العلاج الكيميائي التحريضي لدى المرضى اللائقين ذوي وظائف الكلى والقلب الكافية

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.

HDC–ASCT is recommended as consolidation in fit patients with responsive or stable disease after suitable induction ChT.

Thiotepa-based ASCT conditioning regimens should be used. The dose of thiotepa combined with either busulfan or carmustine should be based on established protocols and informed by patient fitness and comorbidities.

Consolidation WBRT at a dose of 36–40 Gy/20 fractions is recommended in young patients who are not suitable candidates for ASCT.

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.