Sanbo Brain Hospital Case Review: Breaking the Ceiling for Multi-Drug Resistant Recurrent PCNSL

🩺 [The Challenge: A High-Complexity Case]

Aggressive Malignancy: A 46-year-old female diagnosed with Diffuse Large B-cell PCNSL.

Multi-Line Resistance: Following 25 cycles of targeted therapy, the tumor developed profound drug resistance.

Precision Recurrence: The disease recurred along the ventricular wall despite continuous treatment.

Critical Symptoms: Severe cognitive decline and gait instability left the patient with no conventional options.

⚖️ [The Strategy: Why This Specific Regimen?]

Beyond Standards: Standard protocols failed; the Sanbo Brain Hospital Expert Team recognized that simple dose escalation was insufficient.

Multi-Angle Assault: The team pivoted to a synergistic "Chemo-Immuno" combination.

Penetration Backbone: High-Dose Methotrexate (HD-MTX) was used to ensure effective blood-brain barrier penetration.

Synergistic Power: Temozolomide (TMZ) was added to enhance DNA damage and recalibrate the immune microenvironment.

🛠️ [Core: Treatment Essentials]

Dynamic Titration: Real-time monitoring of MTX serum levels to maximize tumor killing while minimizing systemic toxicity.

Myeloid Management: Precise supportive care ensured the patient navigated the bone marrow suppression phase safely.

Immune Activation: Checkpoint inhibitors were used to "unmask" tumor cells and trigger a host immune response.

✨ [Conclusion: Clinical Insights]

Dramatic Remission: After 4 cycles, MRI scans confirmed a significant reduction in multifocal lesions.

Functional Recovery: Cognitive functions were restored, showcasing the expertise of the Sanbo Brain Hospital team in personalized neuro-oncology.