Reinduction therapy followed by SCT

Rituximab + lenalidomide.[4]

Rituximab + lenalidomide + ibrutinib.[5]

Rituximab.[6]

Ibrutinib.[7]

Temozolomide.

Chimeric antigen receptor (CAR) T cells.

DA-TEDDI-R: temozolomide, etoposide, liposomal doxorubicin, dexamethasone, ibrutinib, and rituximab (under clinical evaluation).

A phase I/II clinical trial evaluated CD19-directed CAR T-cell therapy using tisagenlecleucel in patients with relapsed primary CNS lymphoma.[8][Level of evidence C3]CAR T-cell therapy provides an option for patients with relapsed primary CNS lymphoma.[8]

A phase I/II clinical trial evaluated CD19-directed CAR T-cell therapy using tisagenlecleucel in patients with relapsed primary CNS lymphoma.[8][Level of evidence C3]CAR T-cell therapy provides an option for patients with relapsed primary CNS lymphoma.[8]

One-half of the patients (6 of 12) had a complete response.

A phase I/II clinical trial evaluated CD19-directed CAR T-cell therapy using tisagenlecleucel in patients with relapsed primary CNS lymphoma.[8][Level of evidence C3]CAR T-cell therapy provides an option for patients with relapsed primary CNS lymphoma.[8]

Three patients maintained a complete response at 9 months, 12 months, and 23 months at the time of data cutoff.

A phase I/II clinical trial evaluated CD19-directed CAR T-cell therapy using tisagenlecleucel in patients with relapsed primary CNS lymphoma.[8][Level of evidence C3]CAR T-cell therapy provides an option for patients with relapsed primary CNS lymphoma.[8]

Five patients had low-grade immune cell–assisted neurotoxicity.

A phase I/II clinical trial evaluated CD19-directed CAR T-cell therapy using tisagenlecleucel in patients with relapsed primary CNS lymphoma.[8][Level of evidence C3]CAR T-cell therapy provides an option for patients with relapsed primary CNS lymphoma.[8]

One patient had grade 3 neurotoxicity.

The DA-TEDDI-R regimen incorporates temozolomide, etoposide, liposomal doxorubicin, dexamethasone, ibrutinib, and rituximab.[7][Level of evidence C3] Further studies of this regimen are under way (NCT03964090 and NCT02203526). Dexamethasone should be avoided with ibrutinib single agent or combination therapy due to the risk of serious fungal infections. This approach requires access to intravenous antifungal agents not available outside of a clinical trial. By eliminating dexamethasone and ibrutinib, the other drugs may be used together with less risk of fungal infections.

The DA-TEDDI-R regimen incorporates temozolomide, etoposide, liposomal doxorubicin, dexamethasone, ibrutinib, and rituximab.[7][Level of evidence C3] Further studies of this regimen are under way (NCT03964090 and NCT02203526). Dexamethasone should be avoided with ibrutinib single agent or combination therapy due to the risk of serious fungal infections. This approach requires access to intravenous antifungal agents not available outside of a clinical trial. By eliminating dexamethasone and ibrutinib, the other drugs may be used together with less risk of fungal infections.

Among 18 patients who received this regimen (five previously untreated), the complete remission rate was 86%, but high rates (39%) of invasive aspergillosis were reported.

In a phase II study, patients with relapsed or refractory primary CNS lymphoma were treated with rituximab plus lenalidomide.[4][Level of evidence C3]

In a phase II study, patients with relapsed or refractory primary CNS lymphoma were treated with rituximab plus lenalidomide.[4][Level of evidence C3]

An overall response rate of 36% was reported.