SOHO Italy 2025 | The management and subgrouping of CNS lymphomas

So my presentation regarding in particular the recently reported guidelines from the European Haematology Association and the European Society for Medical Oncology. These guidelines is an international effort of a group of experts, focused mostly on the recommendations for the treatment of some subgroups of patients according to the fitness and the comorbidity other than the age. And then we established three main subgroups of patients, the fit patients, mostly young patients to receive chemotherapy, which can be certified in two subgroups according to the ability to receive an autologous stem cell transplantation as part of the treatment, and the last group, the unfit patients, that are not able to tolerate chemotherapy. This is mostly related to the increase in the last 10-20 years of the proportion of elderly patients with primary CNS lymphomas, mostly thanks to the better suspicion and improvement in the technology to achieve an early diagnosis. For patients, for young and fit patients, the conventional treatment is those of a high-dose methotrexate-based polychemotherapy, followed by autologous stem cell transplantation. And with this strategy, a patient who actually responds to chemotherapy exhibits a seven-year overall survival of 70%, which is a very encouraging result. For fit patients that are not able to receive autologous stem cell transplantation, the strategy is those of a similar chemoimmunotherapy followed by whole-brain irradiation or by other forms of consolidation. And finally for unfit patients who are not eligible for chemotherapy, the treatment is mostly based on primary radiation therapy or the use of single drugs, in particular biological agents that were already tested in prospective trials.

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