Primary central nervous system lymphoma treated with high-dose methotrexate and rituximab: A single-institution experience

Abstract

Rituximab (RTX) improves the outcome in patients with systemic diffuse large B-cell lymphoma (DLBCL), but its benefit in primary central nervous system lymphoma (PCNSL) is unclear. In the present study, a single-institution retrospective analysis was performed for 12 patients with newly diagnosed PCNSL treated with combined high-dose methotrexate (HD-MTX) and RTX. MTX was administered biweekly at 8 g/m2/dose until a complete response (CR) was achieved or for a maximum of eight doses. RTX was provided for a total of eight weekly doses at 375 mg/m2/dose. Following a median of 11 cycles of MTX, the radiographic overall response rate was 91% and the CR rate was 58%. A CR was achieved after a median 6 cycles of MTX. The median progression-free survival time was 22 months and the median overall survival time has not yet been attained. These results compare favorably to single-agent HD-MTX and suggest a role for immunochemotherapy in the treatment of PCNSL.

Keywords: high-dose methotrexate; non-Hodgkin's lymphoma; primary central nervous system lymphoma; rituximab.

Figures

Figure 1.

CR with regard to number of administered MTX cycles. The number of patients achieving CR increases with the number of MTX cycles. A minimum of four cycles of MTX had to be administered to achieve a CR. After six cycles, 4 patients had achieved a CR. CR, complete response; MTX, methotrexate.

Figure 2.

Kaplan-Meier estimate of the PFS of three patients (cases 1, 2 and 10) who experienced disease progression after initially achieving a complete response to high-dose methotrexate and rituximab. The median PFS time was 22.1 months. PFS, progression-free survival.