Challenges in the management of primary central nervous system lymphoma

Primary central nervous system lymphoma (PCNSL) is a rare extranodal non-Hodgkin lymphoma. Stereotactic biopsy remains the gold standard for the pathological diagnosis of PCNSL. However, certain new auxiliary diagnostic methods are considered to have good application prospects; these include cytokine and tumor circulating DNA, among others. Although new drugs such as immunomodulators, immune checkpoint inhibitors, chimeric antigen receptor T-cells, and Bruton tyrosine kinase inhibitors have brought hope owing to their improved efficacy, the high recurrence rate and subsequent high mortality remain barriers to long-term survival. Increasing emphasis is therefore being placed on consolidation treatments. Consolidation treatment strategies include whole brain radiotherapy, autologous hematopoietic stem cell transplantation, and non-myeloablative chemotherapy. As studies directly comparing the effectiveness and safety of different consolidation treatment schemes are lacking, the optimal consolidation strategy remains uncertain. This article will review the diagnosis and treatment of PCNSL, focusing on the progress in research pertaining to consolidation therapy.

Automated summary

Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin lymphoma. Stereotactic biopsy is the gold standard for diagnosis, but new auxiliary diagnostic methods such as cytokines and tumor circulating DNA show promise. Consolidation treatments, such as whole brain radiotherapy, autologous hematopoietic stem cell transplantation, and non-myeloablative chemotherapy, are being emphasized but there is uncertainty about the optimal strategy. This article reviews the diagnosis and treatment of PCNSL, focusing on research progress in consolidation therapy.