The Lymphoma Channel on VJHemOnc is an independent medical education platform, supported with funding from AstraZeneca (Diamond), BMS (Gold), Johnson & Johnson (Gold), Takeda (Silver) and Galapagos (Bronze). Supporters have no influence on the production of content. The levels of sponsorship listed are reflective of the amount of funding given.
ICML 2025 | Differences in managing primary versus secondary CNS lymphoma
Nikita Dave, MD, University of Pennsylvania, Philadelphia, PA, discusses the management of primary and secondary central nervous system (CNS) lymphoma, highlighting the significant differences in prognosis and treatment approaches. Dr Dave notes that primary CNS lymphoma requires balancing efficacy and toxicity due to its long-term survival potential, whereas secondary CNS lymphoma has a lower median overall survival and often necessitates consideration of systemic disease. This interview took place during the 18th International Conference on Malignant Lymphoma (18-ICML) in Lugano, Switzerland.
These works are owned by Magdalen Medical Publishing (MMP) and are protected by copyright laws and treaties around the world. All rights are reserved.
Transcript
So I think about primary and secondary CNS lymphoma really differently in that the prognosis is really different. With primary CNS lymphoma, the median overall survival can be a matter of 10 years versus as I’ve been mentioning with secondary CNS lymphoma, it’s much lower. So when I think about how we manage primary CNS lymphoma, I think we need to balance efficacy and toxicity, as I mentioned earlier, because we know that these patients are going to live for a long time...
So I think about primary and secondary CNS lymphoma really differently in that the prognosis is really different. With primary CNS lymphoma, the median overall survival can be a matter of 10 years versus as I’ve been mentioning with secondary CNS lymphoma, it’s much lower. So when I think about how we manage primary CNS lymphoma, I think we need to balance efficacy and toxicity, as I mentioned earlier, because we know that these patients are going to live for a long time. And similar to secondary CNS lymphoma, there’s really no standard of care for how we manage primary CNS lymphoma. I think here in Europe, they go based off of the IELSG32 trial, which was published back in 2016, that typically involves methotrexate followed by an autologous stem cell transplant with thiotepa and carmustine conditioning. That’s sort of, I think, I would say, maybe the standard of care here in Europe, but at least at our institution at the University of Pennsylvania, we’ve seen a lot of toxicity with some of these therapies. So we tend to use a more gentle regimen based off of the Alliance 51101 trial. So this is, again, methotrexate given every two weeks and then spaced to monthly for induction and then for consolidation, an additional six months of therapy. And we found that patients tend to do really well. And again, the toxicity is pretty low. So I think that it’s just really important that we, as I mentioned, just manage toxicity and manage efficacy and methotrexate is really important for that. For secondary CNS lymphoma, what I think about here is that oftentimes it’s really important to think about the patient’s systemic disease as well as their CNS disease. So it can be really hard to manage these patients because they’re so heterogeneous. So I think in terms of how we think about these two patient populations, it’s really different. But it’s nice to have some therapies that we could use in both populations and I’m really excited about all the work that we published in both spaces.
This transcript is AI-generated. While we strive for accuracy, please verify this copy with the video.
Read more...
