Central Nervous System (CNS) lymphoma is also known as primary CNS lymphoma and microglioma, is a type of intracranial tumor observed in patients diagnosed with severe immunosupression (typically patients with AIDS). Primary CNS lymphoma initiates in the spinal cord, brain or meninges. While, most of primary CNS lymphomas are B-cell lymphomas and T-cell lymphomas are rare. The sign and symptoms of primary CNS lymphoma are diplopia, dysphagia, vertigo, monocular vision loss, progressive dementia and facial hypoesthesia. Focal neurological deficit is the most common sign observed in patients affected with CNS lymphoma, followed by neuropsychiatric symptoms, headache/nausea/vomiting due to increased intracranial pressure and seizures. According to World Health Organization (WHO), in 2012 it was witnessed that the prevalence of primary CNS lymphoma substantially increased in couple of decades and represented up to 7% of intracranial tumors around the world for the year. The past increase was partly assisted with growing prevalence of AIDS as well as immunosuppression in solid organ transplant patients. According to a survey carried out by WHO, where they reported that Indolent lymphomas and diffuse large cell B-cell lymphomas have high prevalence rate compared to mantle cell lymphoma, peripheral T-cell lymphoma and composite lymphomas.
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CNS lymphoma is diagnosed with various tests and procedures are as follows:
- Physical exam
- Neurological exam
- Slit-lamp eye exam
- MRI (magnetic resonance imaging)
- CT (computed topography )scan
- PET scan (positron emission tomography scan)
- Lumbar puncture
- Stereotactic biopsy
- Complete blood count (CBC) with differential
- Blood chemistry studies
There are some tests that are carried out on the samples of tissues removed from patient’s body such as flow cytometry, immunohistochemistry and cytogenic analysis. The treatment regime of CNS lymphoma consists of corticosteroids (e.g. prednisolone), chemotherapy (methotrexate with leucovorin), radiation therapy (whole brain radiation therapy) and surgery (stereotactic biopsy). In patients diagnosed with AIDS highly active anti-retroviral therapy (HAART) is used, that affects the CD4+ lymphocytes and the level of immunosuppression observed in the patients. CNS lymphoma is treated with two types of chemotherapies such as intrathecal chemotherapy or intraventricular chemotherapy especially depended on the dose of methotrexate.
The pipeline review of CNS lymphoma drugs comprises upcoming drugs as follows:
- Filgrastim + Rituximab + Methotrexate + Leucovorin + Temozolomide + Cytarabine + Etoposide
- Autologous Immunoglobulin Idiotype-KLH Conjugate Vaccine + Methotrexate + Thiotepa + Sargramostim + Radiation
- Methotrexate + Leucovorin + Dexamethasone
- Idarubicin + Methotrexate + Filgrastim + Ara-C
- procarbazine + lomustine + vincristine + radiation therapy
- HAART + Methotrexate + Rituximab + Leucovorin
- Rituximab + Methotrexate + Teniposide + BCNU + Prednisolone + ARA-C + Radiation Therapy
North America was observed to be the largest market for CNS lymphoma drugs diagnosis and treatment. Advanced technologies and high healthcare awareness are the major factors driving the growth of this market during the study period from 2014 to 2020. Europe was observed to be the second largest market and one of the leading research destinations for neurological and carcinogenic diseases diagnosis and treatment. Asia-Pacific and Rest of the World were observed to be the most potential markets for CNS lymphoma drugs diagnosis and treatment market. These regions lack in advanced infrastructure and disease awareness. The future growth in these geographical regions is expected due to the presence of emerging economies such as China, India, Brazil and other countries that primarily prefer healthcare sector for developmental investment.