OncohematologyOncohematologyОнкогематология1818-83462413-4023Publishing House ABV Press47010.17650/1818-8346-2021-16-2-10-20HEMATOLOGIC MALIGNANCIES: TREATMENTЛЕЧЕНИЕ ГЕМОБЛАСТОЗОВTreatment of primary central nervous system lymphomasЛечение первичных лимфом центральной нервной системыhttps://orcid.org/0000-0001-7096-4700CherkashinaI. V.ЧеркашинаИ. В.
Russian Federation

2nd Botkinskiy Proezd, Moscow 125284

Ирина Васильевна Черкашина

125284 Москва, 2-й Боткинский проезд, 3

laivcher@gmail.comhttps://orcid.org/0000-0003-1497-2436VernyukM. A.ВернюкМ. А.
Russian Federation

2nd Botkinskiy Proezd, Moscow 125284

https://orcid.org/0000-0002-8498-6289ChervontsevaA. M.ЧервонцеваА. М.
Russian Federation

2nd Botkinskiy Proezd, Moscow 125284

125284 Москва, 2-й Боткинский проезд, 3

https://orcid.org/0000-0002-5625-3635GushchinaE. E.ГущинаЕ. Е.
Russian Federation

2nd Botkinskiy Proezd, Moscow 125284

125284 Москва, 2-й Боткинский проезд, 3

https://orcid.org/0000-0001-8520-0711KhayrullinaL. S.ХайруллинаЛ. С.
Russian Federation

2nd Botkinskiy Proezd, Moscow 125284

125284 Москва, 2-й Боткинский проезд, 3

LuninV. V.ЛунинВ. В.
Russian Federation

2nd Botkinskiy Proezd, Moscow 125284

125284 Москва, 2-й Боткинский проезд, 3

https://orcid.org/0000-0003-1564-424XZeynalovaP. A.ЗейналоваП. А.
Russian Federation

111 1st Uspenskoe Shosse, Lapino, Moscow region 143081

43081 Московская обл., д. Лапино, 1-е Успенское шоссе, 111

https://orcid.org/0000-0003-4927-5585FedenkoA. A.ФеденкоА. А.
Russian Federation

2nd Botkinskiy Proezd, Moscow 125284

125284 Москва, 2-й Боткинский проезд, 3

Р.A. Hertzen Moscow Oncology Research Institute - branch of the National Medical Research Radiological Center, Ministry of Health of RussiaМосковский научно-исследовательский онкологический институт им. П.А. Герцена - филиал ФГБУ «Национальный медицинский исследовательский центр радиологии» Минздрава РоссииClinical Hospital “Lapino” of the “Mother and Child” Group of companiesКлинический госпиталь «Лапино» группы компаний «Мать и дитя»0706202116210200306202103062021https://oncohematology.abvpress.ru/ongm/article/view/470

Primary lymphoma of the central nervous system (PLCNS) is a rare form of extranodal lymphoma characterized by an aggressive course. In recent decades, the treatment of this disease has undergone significant changes. Modern treatment of PLCNS consists of two steps – induction and consolidation of remission. Improved overall survival of PLCNS patients was achieved through the use of combined immunochemotherapy regimens with high doses of methotrexate and/or cytarabine, which are currently the standard of induction therapy. High-dose chemotherapy followed by autologous hematopoietic stem cell transplantation at the consolidation stage provides the most complete elimination of the residual tumor clone. The most effective modes of conditioning are those with the inclusion of tiotepa. In elderly and comorbid patients who are not candidates for autologous hematopoietic stem cell transplantation, promising results were obtained while using maintenance therapy with procarbazine or temozolomide, and further researches will allow us to study the effectiveness of monocolonal anti-CD20 antibodies – rituximab and obinutuzumab.Treatment options for patients with relapses and / or refractory forms of PLCNS are limited. Certain successes were obtained with the use of new drugs – ibrutinib, nivolumab, lenalidomide, obinutuzumab.

Первичные лимфомы центральной нервной системы (ПЛЦНС) – редкая форма экстранодальных лимфом, характеризующаяся агрессивным течением. В последние десятилетия терапия этого заболевания претерпела существенные изменения. Современное лечение ПЛЦНС состоит из 2 этапов – индукции и консолидации ремиссии. Увеличение общей выживаемости больных ПЛЦНС было достигнуто за счет использования комбинированных схем иммунохимиотерапии с включением высоких доз метотрексата и/или цитарабина, которые в настоящее время являются стандартом индукционной терапии. Выполнение высокодозной химиотерапии с последующей аутологичной трансплантацией гемопоэтических стволовых клеток на этапе консолидации обеспечивает наиболее полную элиминацию остаточного опухолевого клона. Наиболее эффективны режимы кондиционирования с включением тиотепы. У пожилых и коморбидных пациентов, не являющихся кандидатами для аутологичной трансплантации гемопоэтических стволовых клеток, многообещающие результаты получены при использовании поддерживающей терапии с применением прокарбазина или темозоломида, а дальнейшие исследования позволят изучить эффективность моноколональных анти-CD20-антител – ритуксимаба и обинутузумаба.

Возможности лечения пациентов с рецидивами и/или рефрактерными формами ПЛЦНС ограниченны. Определенные успехи получены при использовании новых препаратов – ибрутиниба, ниволумаба, леналидомида, обинутузумаба.

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