Why International Patients Choose India for Primary CNS Lymphoma Care
GetWellGo connects global patients to India’s top doctors for Primary CNS Lymphoma care—advanced treatments, trusted expertise & affordable healthcare.
The primary CNS lymphoma (PCNSL) is a relatively rare, aggressive non-Hodgkin lymphoma, occurring in the brain, spinal cord, leptomeninges, or eyes, without evidence of 1 systemic disease at the time of detection. It makes up approximately 3-4 percent of all brain tumors, and most frequently a DLBCL.
Primary CNS lymphoma treatment
General Principles:
Surgery does not cure (can only be biopsied).
CNSL is very sensitive to chemotherapy, and to radiotherapy.
Treatment is age-, performance status- and immune status-dependent.
First-Line Treatment
High-Dose Methotrexate (HD-MTX) based Chemotherapy:
Backbone of therapy -administered IV in high doses (>3.5 g/m 2 ), can cross blood-brain barrier.
When used together with:
Cytarabine
Rituximab (anti-CD20 monoclonal antibody)
In some regimens, temozolomide / thiotepa.
Regimens:
MTR (MTX, Cytarabine, Thiotepa, Rituximab) - young fit patients.
HD-MTX – with Cytarabine.
Corticosteroids (e.g. dexamethasone)
Reduce reduction of edema and symptoms.
Supportive therapy, but should not be used before biopsy where possible (can make tumor smaller and difficult to assess).
Consolidation Therapy
Is in an effort to reduce relapse after induction chemo.
Options include:
Auto stem cell transplant (ASCT)
Suitable in younger fit patients.
Stem cell rescue by high dose chemotherapy.
Whole brain Radiotherapy (WBRT)
Effective with adverse effect of associating to neurocognitive loss especially among patients over the age of 60 years.
Administered sparingly (e.g. relapse or where a transplant is impossible).
In selected cases, non myeloablative chemotherapy (e.g. low dose cytarabine, etoposide).
Recurrent / Refractory PCNSL
Rechallenge with HD-MTX in case of good response already.
WBRT (unless utilized in the first place).
Novel/targeted therapies in development
Ibrutinib (BTK inhibitor)
Lenalidomide / Pomalidomide
CAR-T cell therapy (trial).
Supportive Care
Anticonvulsants (should seizures exist).
Therapy of increased pressure in the genesis (mannitol, steroids).
And headache, and nausea, and vomiting (increased intracranial pressure).
Seizures (rarely).
Ocular manifestations (blurred vision, floaters) in symptoms of ocular involvement.
Imaging
MRI Brain with contrast
First-line imaging.
Typical findings:
Solitary or multiple lesions that are homogenously enhancing
Frequently extensive: periventricular white matter, basal ganglia, corpus callosum and thalamus.
On DWI, restricted diffusion.
Less necrosis/ hemorrhage when compared to glioblastoma or metastasis.
Other Imaging
Spinal MRI - when the patient presents with symptoms of a spinal involvement
PET-CT/CT chest, abdomen, and pelvis to exclude the presence of systemic lymphoma (need to confirm that it is primary CNS).
Tissue Diagnosis
Stereotactic brain biopsy
Gold standard to diagnose.
Confirms lymphoma histology (majority of them are Diffuse Large B-cell Lymphoma, DLBCL).
The only notable exception is that corticosteroids should not be administered prior to biopsy, which can result in shrinkage of the tumor that makes diagnosis difficult.
CSF Studies
Lumbar puncture (with the exclusion of raised ICP).
Tests:
Cytology (so as to detect malignant lymphocytes).
Flow cytometry (sensitive).
Molecular (immunoglobulin gene rearrangements).
Ophthalmologic Evaluation
Lit-lamp biomicroscopy + biopsy of vitreous when ocular is seen.
Approximately 20-25 percent of PCNSL patients get affected by the eye.
Laboratory Work-up
PCNSL occurs more frequently in immunocompromised individuals and this could be due to infection with HIV.
There is relevance in the use of EBV testing in patients with immune deficiency.
Basic laboratory work (CBC, kidney, liver) will be performed before a chemotherapy plan is put into session.
Diagnostic Criteria (Summarised)
When an individual experiences loss of neurons, the diagnosis of PCNSL is made.
Lymphoma in CNS /ocular tissue typically DLBCL is confirmed by histopathology.
No systemic lymphoma detected in staging tests (PET-CT/CT scans, bone marrow in case of indication).
Primary CNS lymphoma symptoms
Neurological Symptoms:
Focal deficits (depend on the site of the tumor):
Weakness, or paralysis (motor weakness).
Loss of sensation or burning (hypesthesia).
Wage/ money problems (aphasia).
Blinking problems (field cuts, double vision).
Cognitive / Behavioral Alteration:
Memory loss.
Confusion, disorientation.
Behavioral changes or personality change
Lack of attention and focus.
Increased ICP:
Headaches (generally getting worse in the morning).
Nausea, vomiting.
Papilledema (swelling of disc of eye).
Seizures
Less common than other brain tumors (10-20 percent of patients).
Eye Symptoms (when parts of eyes are affected):
Blurred vision.
Floaters.
Redness or pain of the eye (less frequent).
In severe cases this may result in vision loss.
Involvement of the Spinal Cord (uncommon):
Back pain.
Weak legs.
Dysfunction of the bowel/bladder
Systemic Symptoms
Typically negative, as PCNSL by strict definition involves the confinement of the disease to the CNS/eyes.
Presence of hemorrhage and coined eye 3 weeks earlier → this may indicate secondary CNS lymphoma as a possibility.
Primary CNS lymphoma chemotherapy
Place of Chemotherapy:
The backbone of PCNSL treatment (surgery in biopsy only; radiotherapy restricted with cognitive adverse effects).
Needs agents that penetrate the blood brain barrier.
Administration is usually as induction (initial treatment) and in consolidation.
Induction or First-Line Chemotherapy
Methotrexate (HD-MTX)
Stem of all regimens.
It needs rehydration after which there should be alkalinization of urine with the use of leucovorin rescue to avoid toxicity.
Response rate 50-70 percent.
Combination Regimens:
MTX alone: in elderly patients, weak patients.
HD-MTX with Cytarabine (Ara-C): increases response.
MATRix regimen (administered in younger and able bodied patients):
Methotrexate,
Cytarabine,
Thiotepa,
Rituximab.
High response, more survival rate of modern regimens.
Prevention of infection (particularly intensive regimens) prophylaxis.
Best hospitals for primary CNS lymphoma care
Artemis Hospital, Gurgaon
Medanta-The Medicity, Gurgaon
Fortis Memorial Research Institute, Gurgaon
Max Hospital, Saket
Factors Affecting Primary CNS lymphoma treatment cost in India
The key factors influencing the cost of treating Primary CNS Lymphoma (PCNSL) in India:
Treatment Complexity & Modality
Hospital Type & Location
Diagnostic & Supportive Care Expenses
Drug Sourcing & Generics
Non-Medical Costs
Stage of Disease & Treatment Duration
Top doctors for primary CNS lymphoma treatment
Dr. Priya Tiwari
Dr. Ashok Kumar Vaid
Dr. Kunjahari Medhi
Dr. Rahul Bhargava
Dr. Vinod Raina
Dr. Rayaz Ahmed
Primary CNS lymphoma treatment in India by GetWellGo
GetWellGo is regarded as a leading supplier of healthcare services. We help our foreign clients choose the best treatment locations that suit their needs both financially and medically.
We offer:
Complete transparency
Fair costs.
24 hour availability.
Medical E-visas
Online consultation from recognized Indian experts.
Assistance in selecting India's top hospitals for Primary CNS Lymphoma treatment.
Expert oncologists with a strong track record of success
Assistance during and after the course of treatment.
Language Support
Travel and Accommodation Services
Case manager assigned to every patient to provide seamless support in and out of the hospital like appointment booking
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