Intrathecal anti-CD20 antibody: an effective and safe treatment for leptomeningeal lymphoma

Antonini, Giovanni; Cox, Maria Christina; Madon, E; Ferrari, Antonella; Conte, Esmeralda; Morino, Stefania; Latino, Pamela; Trasimeni, G.; Monarca, Bruno

doi:10.1007/s11060-006-9217-y

Cited by 49 publications

(33 citation statements)

References 10 publications

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“…Promising initial results have been obtained using mafosfamide, lyposomal cytarabine, trastuzumabe, rituximabe, 5-fluoro-2´deoxiuridine, topotecan e nimustine [47][48][49][50][51][52][53][54] . Conventional systemic treatment has variable penetration in the subarachnoid space depending upon the extent of the breakdown of the BBB due to tumor implants and the subjacent inflammatory phenomenon.…”

Section: Treatmentmentioning

confidence: 99%

Meningeal carcinomatosis in solid tumors

Martins¹,

Azevedo²,

Chinen³

et al. 2011

Arq. Neuro-Psiquiatr.

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The involvement of the leptomeninges by metastatic tumors can be observed in solid tumors, in which case it is termed meningeal carcinomatosis (MC), and in lymphoproliferative malignant disease. It is more common in breast and lung cancer, as well as melanoma, with adenocarcinoma being the most frequent histological type. MC is usually a late event, with disseminated and progressive disease already present and, it is characterized by multifocal neurological signs and symptoms. Diagnosis is based on the evaluation of clinical presentation, cerebrospinal fluid and neuroimaging studies. The better systemic disease control is observed with new therapeutic agents, and the development of neuroimaging methods is responsible for the increasing incidence of such metastatic evolution. Intrathecal chemotherapy is generally the treatment of choice, although frequently palliative. Prognosis is guarded, although a higher performance status may indicate a subgroup of patients with a more favorable outcome. Key words: meningeal carcinomatosis, cerebrospinal fluid, meninges, chemotherapy, metastases.Carcinomatose meníngea em tumores sólidos RESUMO O acometimento leptomeníngeo por metástases tumorais pode ocorrer em tumores sólidos, sendo chamado de carcinomatose meníngea (CM), e também em doenças linfoproliferativas. Tumores de mama, pulmão e melanoma são os principais responsáveis pelos casos, e adenocarcinoma é a histologia mais frequentemente encontrada. A CM é um evento tardio na evolução da doença e caracteriza-se por sinais e sintomas neurológicos multifocais. O diagnóstico se faz pela avaliação conjunta do quadro clínico, neuroimagem e estudo do líquido cefalorraquidiano. O maior controle da doença sistêmica obtido com as novas modalidades terapêuticas e a baixa penetração de drogas no sistema nervoso central, aliados ao desenvolvimento nos métodos de neuroimagem observado nas últimas décadas, são fatores que respondem por um aumento na incidência desta apresentação. A quimioterapia intratecal é o tratamento de escolha, porém, frequentemente paliativo. O prognóstico é reservado, sendo que o melhor performance status pode selecionar um subgrupo de pacientes com melhor evolução. Palavras-Chave: carcinomatose meníngea, líquido cefalorraquidiano, meninges, quimioterapia, metástase.

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Section: Treatmentmentioning

confidence: 99%

Meningeal carcinomatosis in solid tumors

Martins¹,

Azevedo²,

Chinen³

et al. 2011

Arq. Neuro-Psiquiatr.

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“…[23][24][25][26][27][28][29] Doses ranged from 10 to 40 mg and were most commonly initiated at 10 mg and increased to the highest tolerated dose or until acceptable clinical response occurred. All 7 patients showed response in tumor cell clearance.…”

Section: Lymphoma and Intrathecal Rituximabmentioning

confidence: 99%

“…Cytologic responses were also accompanied with symptomatic improvements in 4 cases and included neurologic improvements, disappearance of seizures and headaches, and cognitive improvement. 24,25,27,28 Only 1 report described progression of CNS lymphoma. 26 Survival in these 7 case reports ranged from 4 months to greater than 3.5 years.…”

Section: Lymphoma and Intrathecal Rituximabmentioning

confidence: 99%

“…Three of 7 patients received high-dose chemotherapy with autologous stem cell rescue after receiving intrathecal rituximab. 23,24,29 Adverse effects reported include neuropathic pain, headache, cramps, back pain, and leg weakness. Infusion reactions characterized by tingling sensations in the extremities, transient upward gaze of eyes, nausea, chills, hypotension, and disorientation were reported.…”

Section: Lymphoma and Intrathecal Rituximabmentioning

confidence: 99%

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Role of Intrathecal Rituximab and Trastuzumab in the Management of Leptomeningeal Carcinomatosis

Perissinotti

Reeves

2010

Ann Pharmacother

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“…After intravenous administration of rituximab CSF concentration remains very low, ranging from 0.1 to 0.2% of systemic rituximab concentration [23]. Results in patients with B cell lymphoid malignancies with leptomeningeal infiltration suggest that IT or intraventricular rituximab may have a therapeutic effect [9,[24][25][26][27][28][29]. IT or intraventricular administration of rituximab could be a useful addition to therapy of patients with B-cell malignancies involving the CNS and possibly also could be considered for prophylaxis for malignancies with risks of CNS recurrence.…”

mentioning

confidence: 99%

Safety and efficacy of intrathecal rituximab in children with B cell lymphoid CD20+ malignancies: An international retrospective study

et al. 2016

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Central nervous system (CNS) involvement in patients with mature B non-Hodgkin lymphoma, posttransplantation proliferative disorder and acute lymphoblastic leukemia confers a significantly inferior prognosis as compared to patients without CNS disease. Intrathecal (IT) or intraventricular administration of rituximab is an option for this group of patients. We report 25 children with CNS involvement of CD201 B lymphoid malignancies who received in total 163 IT/intraventricular rituximab doses. The median number of doses received by each patient was 6, with a median dose of 25 mg. The most common adverse events were Grades 1 and 2 peripheral neuropathies in five patients (20%), allergy in two patients, and headache in two patients. These events were self-limited, occurring in the 48 hours after treatment and resolving within 24 hr. Three patients presented with more severe though transient side effects, one with a Grade III neuropathy and two with seizure. Eighteen patients (72%) of those treated with IT/intraventricular rituximab, with or without other CNS directed treatment, achieved a CNS remission. This case series suggests that IT/ intraventricular rituximab has therapeutic efficacy and relatively limited toxicity. Prospective trials of IT/ intraventricular rituximab for patients with CNS involvement of CD20 1 B lymphoid malignancies are warranted.

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Intrathecal anti-CD20 antibody: an effective and safe treatment for leptomeningeal lymphoma

Cited by 49 publications

References 10 publications

Meningeal carcinomatosis in solid tumors

Meningeal carcinomatosis in solid tumors

Role of Intrathecal Rituximab and Trastuzumab in the Management of Leptomeningeal Carcinomatosis

Safety and efficacy of intrathecal rituximab in children with B cell lymphoid CD20+ malignancies: An international retrospective study

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