ICML 2025 | Ongoing research in the field of CNS lymphoma: improving patient outcomes & reducing toxicities

I think this is definitely an area ripe for research. There are many ways that we can come at this to improve outcomes and reduce toxicity, which is always our goal in this disease. For further reducing toxicity, there are several studies going on to optimize induction regimens. We talk a lot about consolidation regimens and how to select the best consolidation regimen. But as I mentioned, our data showed that even after just the induction regimen, people have some neurotoxicity. So how can we optimize an induction? I’m also excited that there is more work going into optimizing the conditioning regimen for autologous stem cell transplant so that more patients can be eligible for transplant. So I think that’s all exciting. Novel therapeutics. I mean, we know CAR T-cell therapy, that’s been evaluated in CNS lymphoma in the relapsed/refractory setting. BTK inhibitors are very exciting and used in relapsed/refractory and starting to get used more in the upfront maintenance therapy setting. All of that is very exciting. I think as a radiation oncologist, my number one goal is how can we get patients to these novel therapies? A lot of the trials say, oh, if you have a complete response to induction or you’re in a complete response, then you can have this other therapy. But there are a lot of patients who aren’t in a complete response, who have some element of residual disease. So how do we get patients to those new therapies? I’m very excited to use radiation. We don’t have to necessarily think of it as whole brain radiation, big volumes, big doses. Now in the new era, if we’re bridging you to some other therapy that’s very exciting and can take care of that microscopic disease, is it safe and effective to use focused radiation just to the site of disease and bridge you and get you on to that new therapeutic? So I think that’s the most exciting area that we really need to get more data on to understand safety and efficacy there. Because I think from my own experience and talking to my colleagues, a lot of us are starting to do this now. I’m spearheading with Dr. Brandon Imber at Sloan Kettering. We’re spearheading multi-institutional efforts really to put all of our data together. Because again, this is a very heterogeneous group of patients with different histologies, different presentations. And so it’s hard to come to conclusions with just small numbers for each scenario. But if we put our heads together, which we’re doing through the International Lymphoma Radiation Oncology group, the ILROG, we’re putting our heads together and we actually have a multi-institutional effort now to combine all of our data on radiation for secondary CNS lymphoma so that we can start to understand our current patterns of utilization of radiation, doses, volumes, indications, put all that together so we can come up with some clear guidelines and prospective trials that we can use, I think, to incorporate radiation in the new era.

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