Primary CNS Lymphoma: A Sneak Peek at New Research from this Year’s ASH Meeting
Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin lymphoma that originates in the lymphocytes within the central nervous system (the brain or spinal cord). The cancer can lead to marked cognitive and behavioral changes, limb weakness, brain swelling, speaking problems, and vision issues.[]
PCNSL is generally seen in older and immunocompromised patients, especially those with HIV or AIDS—and the incidence is increasing.[] Yet despite growing understanding around this type of cancer, researchers still aren’t entirely sure how best to treat it. In fact, experts say that with only an estimated 1,500 patients diagnosed annually in the US[], there just haven’t been enough trials to guide treatment strategies.[]
Fortunately, this year’s American Society of Hematology (ASH) Annual Meeting and Exposition in Orlando, Florida conference will present an opportunity to challenge those knowledge gaps, with a substantial body of new research being presented.
PCNSL: Optimal treatment strategies on the horizon
Among the research being presented is a study on treatment protocols published in ASH Publications earlier this year. The researchers conducted a retrospective analysis of patients diagnosed with PCNSL at the University of Pennsylvania between 2008 and 2024, and found that while PCNSL is typically treated with high-dose methotrexate followed by stem cell transplant, whole-brain radiation, or prolonged chemotherapy, there may be a better approach: “6 doses of methotrexate, temozolomide, and rituximab (MTR) induction with methotrexate on day 15 until complete response for induction followed by 6 monthly cycles of MTR.”
They concluded that, “prolonged MTR is a safe treatment option and an alternative to intensified consolidation strategies.” While additional randomized studies are necessary to determine the optimal treatment strategy in newly diagnosed PCNSL, these findings provide some level of clarity for clinicians treating PCNSL.
On the other hand, researchers also note that high-dose methotrexate may not be the best option for many patients, due to performance status and organ dysfunction. For this reason, “current research has focused on introducing targeted immunotherapies into the induction, salvage, and consolidation treatments of PCNSL.”