# Orelabrutinib plus reduced-dose whole brain radiotherapy in elderly primary central nervous system lymphoma: a case report

## TL;DR

This case report explores a new treatment combining reduced-dose brain radiation and orelabrutinib for elderly patients with brain lymphoma who cannot tolerate standard chemotherapy.

## Contribution

The study introduces a novel, less toxic treatment combination for elderly PCNSL patients ineligible for standard chemotherapy.

## Key findings

- All three patients achieved complete or partial remission with the treatment combination.
- Two patients maintained durable remission, while one relapsed after switching regimens.
- No significant neurotoxicity or complications were observed with the treatment.

## Abstract

Primary central nervous system lymphoma (PCNSL) primarily affects elderly individuals, many of whom are unable to tolerate standard high-dose methotrexate (HD-MTX) chemotherapy due to frailty and comorbid conditions. There is a pressing need for alternative treatment strategies that offer reduced toxicity while maintaining therapeutic efficacy.

In this case report, we describe three elderly patients (aged 70–78 years) with newly diagnosed, chemotherapy-ineligible PCNSL who were treated with a combination of reduced-dose whole brain radiotherapy (rd-WBRT, <30 Gy) and oral orelabrutinib (150 mg daily).

These preliminary findings suggest that the all patients initially achieved either complete remission (CR) or partial remission (PR). Two patients maintained durable remission, whereas one patient experienced disease relapse after discontinuing orelabrutinib and switching to an alternative regimen. No significant neurotoxicity or treatment-related complications were observed. Combination of orelabrutinib and rd-WBRT may represent a safe and effective therapeutic approach for elderly patients with PCNSL who are not candidates for standard chemotherapy. Prospective clinical trials are warranted to further evaluate this approach.