Managing primary central nervous system lymphoma (PCNSL) in patients over 60 requires a distinct approach. Age is a key factor in both treatment selection and the avoidance of specific consolidation modalities that carry unacceptable risks in this group.
This protocol applies to patients aged over 60 years with primary central nervous system lymphoma. In this age group, the risk profile for certain consolidation strategies changes substantially, requiring careful adaptation of the standard approach.
Whole brain radiotherapy (WBRT) is avoided in elderly patients (>60 years). The risk of delayed neurotoxicity following WBRT — particularly after high-dose methotrexate-based induction — is unacceptably high in this population.
For fit patients in this age group, consolidation with high-dose chemotherapy and autologous stem cell transplantation using a thiotepa-based conditioning regimen is among the approaches considered. The full structured regimen — including eligibility criteria, sequencing, and clinical decision points — is available via the protocol.
DOI: 10.1093/neuonc/noac196
In patients >60 years, the risk of delayed neurotoxicity, after WBRT especially if following HDMTX, is unacceptably high and WBRT should be avoided in these elderly patients (Level B).
A retrospective European study has suggested that HDC/ASCT with a thiotepa-based conditioning regimen is also feasible and effective in PCNSL patients over the age of 65 (Class IIIb).
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