Recurrent lymphomatous meningitis treated with intra-CSF rituximab and liposomal ara-C

Abstract

The combination of intra-CSF liposomal ara-C and rituximab administered in this schedule appears to have no additive toxicity and has modest palliative activity in patients with recurrent LM.

Intrathecal liposomal cytarabine (lipoCIT) administration in patients with leukemic or lymphomatous meningitis

“…10, maintenance therapy = dauxorubicine d1 + cytarabine x mg/m2 subcutaneous d1-5 every 3 months + hydroxyurea PO + purinethol PO injections in 1 patient who presented blurred vision and headaches; cauda equina syndrome after, respectively, 6 and 3 lipoCIT injections in 2 separate cases; and encephalitis leading to death after 3 lipoCIT injections in 1 case. Two patients from this series also received off-label, highdose rituximab in association with hyper-CVAD; rituximab has already been associated with neurotoxicity (rituximab monograph, ROCHE, Neuilly-sur-Seine, France) [12]. Chamberlain et al discussed the published cases and assured that all described symptoms were not specific to lipoCIT administration, whereas Thomas et al affirmed the responsibility of lipoCIT in the described cases [13].…”

Intra-CSF administration of chemotherapy medications

“…Rituximab has been used for the treatment of relapsed or refractory CNS lymphomas. Most patients achieved a partial or complete remission as described in available case reports [63][64][65][66][67][68][69][70][71][72][73][74]. For both of these agents, dose and duration of treatment were variable.…”

“…In addition, 10 case reports described intrathecal rituximab administration for the treatment of primary CNS lymphomas, either refractory or relapsed [63][64][65][66][67][68][69][70][71][72]. Rituximab dosing was variable, ranging from 10 to 50 mg.…”

Neurological Complications of Non-Hodgkin Lymphoma

“…Interestingly, one patient exhibited resolution of a brain lesion after IT rituximab treatment. In a small retrospective study, IT rituximab was given in combination with liposomal cytarabine to patients with recurrent LM [42]. Modest palliative activity was observed, with 10/14 partial responses lasting a median time of 4 months; median overall survival was 5 months.…”