Treatment of Relapsed or Refractory Primary Central Nervous System Lymphoma
When primary central nervous system lymphoma (PCNSL) relapses or fails to respond to initial therapy, treatment decisions require careful individualisation. The choice of salvage approach is guided by performance status, comorbidities, prior treatments received, and the interval since last treatment.
This protocol applies to patients with PCNSL experiencing relapsed or refractory disease. No single salvage strategy fits all patients — clinicians must assess each case according to fitness for intensive therapy, prior treatment history, and whether prior regimens achieved a meaningful response.
Treatment Approach
Salvage options may include chemotherapy re-challenge in patients who previously responded, reinduction-based combinations prior to consolidation, and high-dose consolidation for fit patients with chemosensitive relapse. Radiotherapy, novel targeted agents, and immunotherapy approaches may also be considered depending on prior treatment history and individual patient factors.
Full regimen details, selection criteria, sequencing, and consolidation strategy — see the complete protocol.
References
DOI: 10.1093/neuonc/noac196
- MTX re-challenge should be considered in recurrent PCNSL patients who previously responded to HD MTX (Level C).
- HDC/ASCT is a valid therapeutic option in patients aged <70 years with chemosensitive relapsing PCNSL especially in patients without prior ASCT (Level B).
- Salvage WBRT may be proposed in radiotherapy-naïve patients; it may be preceded by induction chemotherapy (Good Practice Point).
- Bruton Tyrosine kinase inhibitors, imids, immune checkpoint inhibitors and CART have shown clinical activity as single agents in relapsing PCNSL and may be considered in salvage treatments.
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