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Flows and flaws in primary central nervous system lymphoma

Nature Reviews Clinical Oncology volume 7, pages 1–2 (2010)Cite this article

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We read with great interest the article by Ansell and Rajkumar (Trials and tribulations in primary CNS lymphoma. Nat. Rev. Clin. Oncol. 7, 125–126; 2010), proposing an algorithm for treatment of primary central nervous system lymphoma (PCNSL).1 The authors are to be commended for their effort to construct a therapeutic flow chart in a field where level of evidence is very low. As a natural consequence, some of their recommendations deserve to be better discussed and the use of the proposed algorithm in the everyday practice should be taken into account with caution.

The key decisional intersection in the algorithm proposed by Ansell and Rajkumar is patient eligibility for high-dose chemotherapy supported by autologous stem-cell transplantation (HDC–ASCT). Such an approach is, however, hardly applicable in practice, considering that worldwide experience with this strategy in PCNSL is limited to small retrospective series and a few phase II trials.2 This preliminary experience seems to suggest that HDC–ASCT is feasible in young and fit patients, and is associated with encouraging results, mostly if a thiotepa-containing conditioning regimen is used.2 However, these observations, as well as the hypothesis that HDC–ASCT is associated with better neurotolerability with respect to consolidation whole-brain irradiation, remain to be addressed in future randomized trials.

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Figure 1: Flow chart of the IELSG #32 trial (clinicaltrials.gov: NCT01011920).

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Acknowledgements

The authors wish to thank Michele Reni (Medial Oncology Unit, San Raffaele Scientific Institute, Milan, Italy) and Jürgen Finke (Department of Hematology and Oncology, University Medical Center, Freiburg, Germany) for their excellent assistance with the manuscript.

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Authors and Affiliations

  1. Department of Oncology, Unit of Lymphoid Malignancies, San Raffaele Scientific Institute, Via Olgettina 60, Milan, 20132, Italy

    Andrés J. M. Ferreri

  2. Department of Hematology and Oncology, University Medical Center, Hugstetter Street 55, 79106, Freiburg, Germany

    Gerald Illerhaus

  3. Istituto Oncologico della Svizzera Italiana, Ospedale San Giovanni, Viale Officina 3, CH 6500, Bellinzona, Switzerland

    Emanuele Zucca & Franco Cavalli

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Correspondence to Andrés J. M. Ferreri.

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Ferreri, A., Illerhaus, G., Zucca, E. et al. Flows and flaws in primary central nervous system lymphoma. Nat Rev Clin Oncol 7, 1–2 (2010). https://doi.org/10.1038/nrclinonc.2010.9-c1

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