Diagnosis and management of vitreoretinal lymphoma: present and future treatment perspectives

被引:3
|
作者
Kaburaki, Toshikatsu [1 ,2 ]
Taoka, Kazuki [2 ]
机构
[1] Jichi Med Univ, Dept Ophthalmol, Saitama Med Ctr, 1-847 Amanuma,Ohmiya Ku, Saitama, Saitama 3308503, Japan
[2] Univ Tokyo, Dept Ophthalmol, Grad Sch Med, Bunkyo Ku, Tokyo, Japan
基金
日本学术振兴会;
关键词
Intraocular lymphoma; Vitreoretinal lymphoma; Central nervous system lymphoma; Diagnosis; Treatment; PRIMARY INTRAOCULAR LYMPHOMA; NERVOUS-SYSTEM LYMPHOMA; B-CELL LYMPHOMA; HIGH-DOSE METHOTREXATE; PRIMARY CNS LYMPHOMA; INTRAVITREAL METHOTREXATE; CLINICAL-FEATURES; EPIDEMIOLOGIC SURVEY; SINGLE-CENTER; PHASE-II;
D O I
10.1007/s10384-023-00997-6
中图分类号
R77 [眼科学];
学科分类号
100212 ;
摘要
Intraocular lymphoma (IOL) is a rare malignant intraocular lymphocytic tumor that mimics uveitis. IOL is anatomically classified into vitreoretinal lymphoma (VRL) and uveal lymphoma; most IOLs are VRLs, while uveal lymphoma is rare. VRL is highly malignant, with 60%-85% of patients developing central nervous system (CNS) lymphoma; primary VRL (PVRL) is an ocular disease with poor prognosis. We aimed to review the management and both current and future treatments for VRL. VRL diagnosis is based on the results of cytopathological examination using vitreous biopsy. However, the positive ratio of vitreous cytology remains 29%-70%. A combination of adjunctive tests may improve diagnostic accuracy, but as yet no gold-standard regimen has been established. Methotrexate intravitreal injections are effective in controlling ocular lesions; however, this treatment allows CNS dissemination. The efficacy of systemic chemotherapy in suppressing CNS dissemination has been recently debated. A multicenter prospective study with a unified treatment protocol is required to clarify this issue. In addition, establishing a treatment protocol for elderly patients and those with poor general health is necessary. Moreover, relapsed/refractory VRL and secondary VRL are more difficult to treat than PVRL because they are prone to recurrence. Ibrutinib, lenalidomide with or without rituximab, and temozolomide are promising treatments for relapsed/refractory VRL. In Japan, Bruton's tyrosine kinase (BTK) inhibitors have been approved for treating refractory CNS lymphoma. Furthermore, a randomized prospective study of tirabrutinib, a highly selective BTK inhibitor, is ongoing for evaluating the suppressing of CNS progression in patients with PVRL.
引用
收藏
页码:363 / 381
页数:19
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