Abstract
Simple SummaryWe present a review of the most relevant epidemiological, diagnostic and therapeutic aspects of primary central nervous system lymphoma (PCNSL) in elderly patients.The management of elderly patients suffering from primary central nervous system (CNS) lymphoma, who represent a rapidly growing population, is challenging. Despite the advances made in PCNSL treatment, the prognosis in older patients remains unsatisfactory. The high risk of systemic and CNS toxicity induced by a high-dose chemotherapy regimen and radiation therapy, respectively, limits the use of consolidation phase treatments in elderly patients and contributes to the poor outcome of these patients. Here, we review the current treatment strategies and ongoing trials proposed for elderly PCNSL patients.
Highlights
Cancers 2021, 13, 3479. https://Primary central nervous system lymphoma (PCNSL) is a highly aggressive nonHodgkin lymphoma confined to the central nervous system (CNS) and mainly affects elderly patients
Cytarabine) in patients with lymphomatous meningitis treated with HD-MTX has not been established in the absence of controlled trials. These drugs are likely delivered through an intraventricular Ommaya reservoir with a reservoir infection rate of 9% [68]. This approach was proposed in some chemotherapy regimens, including those used with elderly patients [9,68,69,70], and may be discussed when intravenous MTX is administered at doses below 3 g/m2, to allow reaching cytotoxic levels in the CSF
Patients represent the majority of PCNSL patients with an increasing incidence over time
Summary
Primary central nervous system lymphoma (PCNSL) is a highly aggressive nonHodgkin lymphoma confined to the central nervous system (CNS) and mainly affects elderly patients. A Dutch nationwide population-based study revealed that, while the use of chemotherapy has progressively increased in elderly patients up to age 70 years, with a consequent improvement in OS, approximately 40% of patients older than 70 years did not receive antineoplastic therapy, exhibiting poor prognosis [4]. Physiological status related to age, higher rate of comorbidities and differences in therapeutic management may contribute to the poorer prognosis in elderly patients with PCNSL and warrant to be better investigated and taken into account, in order to optimize management strategies and tolerance and improve outcomes This evidence supports the development of clinical trials dedicated to elderly patients with PCNSL, considering the specific risks of this age group. This review focuses on the main management issues and therapeutic perspectives for elderly patients with PCNSL
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