RESUMO
BACKGROUND: Despite improvements in surgical technique, radiation therapy delivery, and options for systemic cytotoxic therapy, the median survival for patients with newly diagnosed glioblastoma multiforme remains poor at 15 months with trimodality therapy. Multiple immunologic approaches are being tested to enhance the response of these tumors to existing therapy and/or to stimulate innate immune responses. METHODS: We review the existing data that support the continued development of immunologic therapy in the treatment armamentarium against glioblastoma multiforme, with a focus on clinical data documenting outcomes. RESULTS: In phase I and phase II trials, antitumor vaccines (dendritic and formalin-fixed) have demonstrated clinical efficacy with mild toxicity, suggesting that innate immune responses can be amplified and directed against these tumors. Suicide gene therapy (gene-mediated cytotoxic therapy) using a number of viral vectors and molecular pathways has also shown efficacy in completed phase I and ongoing phase II trials. In addition, neural stem cells are being investigated as vectors in this approach. CONCLUSIONS: Although phase III data are needed before immunologic therapies can be widely implemented into clinical practice, the existing phase I and phase II data suggest that these therapies can produce meaningful and sometimes durable responses in patients with glioblastoma multiforme with mild toxicity compared with other existing therapies.
Assuntos
Neoplasias Encefálicas/terapia , Vacinas Anticâncer/uso terapêutico , Terapia Genética/métodos , Glioblastoma/terapia , Imunoterapia/métodos , Neoplasias Encefálicas/genética , Neoplasias Encefálicas/imunologia , Células Dendríticas/imunologia , Glioblastoma/genética , Glioblastoma/imunologia , Humanos , Taxa de Sobrevida , Resultado do TratamentoRESUMO
Brain parenchymal involvement by mantle cell lymphoma is rare and confers a grim prognosis. More commonly, patients with central nervous system manifestations of mantle cell lymphoma have leptomeningeal involvement on radiographic studies with malignant cells found in the cerebrospinal fluid. Risk factors for central nervous system involvement include a high proliferation index, bone marrow involvement, and blastoid morphology. We present an unusual case of a biopsy-proven mantle cell lymphoma mass lesion in the brain parenchyma as the presentation of relapse 6 months after diagnosis.
