CNS Lymphoma

Question 1

What type of lymphoma most commonly causes PCNSL?

Answer 1

DLBCL

Question 2

What percentage have leptomeningeal dissemination?

Answer 2

16%

Question 3

What investigations should be performed?

Answer 3

Full neuro exam
Fund is copy & slit lamp
Blds - LDH, Renal & liver profile, FBC, HIV & hep B&C serology
Gadolidium enhanced MR brain and spine
PET/CT
Testicular USS
Histology - stereotactic/surgical biopsy or vitrectomy specimen (if ocular) or CSF if nil other diagnostic

Question 4

What should you do if a pt has been commenced on corticosteroids and the suspected lesion has resolved?

Answer 4

Re-image with MRI after 2-4/52 of stopping steroids. Then serial imaging with urgent biopsy at first sign of regrowth

Question 5

What is the optimal treatment for PCNSL if pt fitness allows?

Answer 5

Remission induction with 4x MATRix with MR after 1 cycle and PBSC after C2. Then consolidation therapy with Thiotepa/BCNU HDT-ASCT

3y OS 70-80%

Question 6

What consolidation therapy would you offer if someone is ineligible for HDT-ASCT?

Answer 6

36Gy/20# WBRT with possible 9Gy boost to residual enhancement
Orbits shielded after 30Gy if no previous ocular disease

Question 7

What treatments could you consider for pts who are ineligible for HD-MTX?

Answer 7

Corticosteroids
WBRT
Temozolamide
BSC

Question 8

What is the median OS at relapse?

Answer 8

3.5m