IL-4 CHALLENGES FOR MANAGEMENT OF PRIMARY CNS LYMPHOMA

Primary central nervous system lymphoma (PCNSL) affects primarily elderly patients and comprises 5% of all primary brain tumors with predominant histology of diffuse large B-cell lymphoma (DLBCL). Whole brain radiotherapy (WBRT) does not provide durable remission, rather is deeply involved in development of leukoencephalopathy with delayed neurotoxicity, especially in elderly patients. BBB-penetrating high-dose methotrexate (HD-MTX)-based multiagent immunochemotherapies have been extensively explored and have shown high activities as induction regimens, followed by consolidation therapies such as high-dose chemotherapy with autologous stem-cell transplant (HDC/ASCT). Recent progress in understanding molecular pathogenesis of PCNSL has shed light on developing novel molecular targeted therapies against key signaling molecules such as Bruton’s tyrosine kinase (BTK) and pathways leading to constitutive activation of NF-kB signaling. In this lecture, standard of care for PCNSL with its molecular landscape and issues to be pursuit to further improve outcome of PCNSL treatment will be discussed.