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Management of Central Nervous System Lymphomas Using Monoclonal Antibodies: Challenges and Opportunities

Author's Affiliation: Department of Neurology and Neuro-Oncology Unit, Harvard Medical School and Beth Israel Deaconess Medical Center, Boston, Massachusetts

Requests for reprints: Eric T. Wong, Brain Tumor Center, Department of Neurology and Neuro-Oncology Unit, Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215. Phone: 617-667-1665; Fax: 617-667-1664; E-mail: ewong{at}bidmc.harvard.edu.

Monoclonal antibodies (mAb) may change the management of central nervous system (CNS) lymphomas. This is due to the fact that traditional chemotherapies lack specificity for B-lymphoma cells and blood-brain barrier prevents adequate chemotherapy dosing in the CNS without significant systemic side effects. But in the past 5 years, the emergence of mAbs against specific receptors on B-lymphoma cells, either as a single agent or in combination with cytotoxic chemotherapies, may offer a better therapeutic index than conventional chemotherapies. The advantages of mAbs include high affinity to targets on lymphoma cells, their lack of pharmacodynamic or pharmacokinetic interactions with other drugs, and a potential for a synergistic therapeutic response when combined with conventional chemotherapies. Our review summarizes the biological behaviors of CNS lymphomas and the challenges and opportunities in using mAbs for CNS lymphomas.