No association between temozolomide maintenance and survival after first‐line treatment in primary CNS lymphoma
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive form of diffuse large B ‐ cell lymphoma (DLBCL) characterized by infiltration of malignant B cells into the central nervous system (CNS). 1 Fit patients are treated with high ‐ dose methotrexate (HD ‐ MTX) – based polychemotherapy followed by thiotepa ‐ containing high ‐ dose chemotherapy and autologous stem cell transplantation (ASCT). 2 For patients unsuitable for ASCT, induction treatment is consolidated with high ‐ dose cytarabine and low ‐ dose whole ‐ brain radiotherapy (WBRT). 1,2 Patients unsuitable for HD ‐ MTX can receive first ‐ line treatment with a single alkylator, such as temozolomide (TMZ) and WBRT. Despite therapeutic advances and high response rates, over half of the patients with PCNSL relapse within 2 years after diagnosis. 3 TMZ maintenance treatment has been suggested to reduce relapse rates and improve overall survival (OS) for patients with post ‐ induction complete remission (CR) or partial remission (PR). Therefore, its administration is supported by international guidelines, including the European Hematology Association and European Society for Medical Oncology (EHA ‐ ESMO) joint recommendations 2 and the National Comprehensive Cancer Network (NCCN) Guidelines for B ‐ Cell Lymphomas (Version 3.2026). However, implementation of TMZ maintenance varies across clinical settings, allowing real ‐ world evaluation of the association between TMZ