CNS lymphoma Flashcards
Gene mutations to know commonly occurring in primary CNS lymphoma
MYD88 and CD79B
Imaging characteristics of primary CNS lymphoma 2) how to differentiate from brain mets
**Single periventricular irregularly shaped lesion
*restricted diffusion on diffusion-weighted images
*homogeneously enhancing, dark/hyperintense on T2 *moderate vasogenic edema (as compared to brain tumors or mets)
Workup if imaging concerning for primary CNS lymphoma
Avoid steroids (cytotoxic to lymphoma cells, can increase risk for a nondiagnostic biopsy)
MRI brain w/ w/o contrast
Slit lamp evaluation and fundoscopy
LP w/ CSF and cytology
IF CSF cytology negative AND tissue safely obtainable, consult NSGY for stereotactic biopsy (Tissue mandatory for diagnosis)
IF inaccessible, radiographic diagnosis based on MRI
Staging workup of PCNSL
PET/CT (rule out extracranial lymphoma)
MRI whole spine to rule out leptomeningeal disease
Ophthalmology referral slit lamp examination to rule out ocular involvement (25% w/ ocular involvement)
IF older OR testicular exam abnormal, testicular US
Role of IT MTX for PCNSL
Intrathecal methotrexate has been eliminated from most induction chemotherapy regimens for PCNSL, even for patients with evidence of CSF dissemination. This is largely based on research showing that IV methotrexate, at least at doses >3 g/m2, consistently achieves micromolar concentrations in the CSF [36-40]. In addition, placement of an Ommaya reservoir for repeated doses of intrathecal drug confers risk of infection and other complications
Methotrexate reversal agent
glucarpidase
Regimens in general for PCNSL and dose
high-dose methotrexate-based combination regimen (greater than 3.5 g/m2 for CNS penetration) w/ leucovorin rescue
Primary comorbidity conferring increased risk of toxicity with high dose MTX
renal function
Consolidation for PCNSL
IF young AND FIT AND CR/PR, thiotepa-based HDC-auto transplant
IF transplant ineligible AND age <75, chemo - high-dose cytarabine vs. etoposide plus cytarabine
