Systemic high-dose methotrexate plus ifosfamide is highly effective for central nervous system (CNS) involvement of lymphoma

Fischer, Lars; Korfel, Agnieszka; Kiewe, Philipp; Neumann, Martin; Jahnke, Kristoph; Thiel, Eckhard

doi:10.1007/s00277-008-0575-8

Cited by 17 publications

(9 citation statements)

References 32 publications

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“…Only one study has been published on patients treated after 2002 but in this series only 8/20 patients had recurrent systemic lymphoma; the others had relapsed primary CNS lymphoma. 15 Although our study is retrospective, it comprises the only series of patients diagnosed with CNS recurrence of systemic lymphoma in the CSF and/or brain parenchyma treated in the last 10 years. Our 3-year survival rate of 22% seems better than that previously found in CNS recurrent aggressive lymphoma before stem cell transplantation became available.…”

Section: Discussionmentioning

confidence: 99%

Central nervous system recurrence of systemic lymphoma in the era of stem cell transplantation - an International Primary Central Nervous System Lymphoma Study Group project

et al. 2012

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Autologous stem cell transplantation has greatly improved the prognosis of systemic recurrent non-Hodgkin's lymphoma. However, no prospective data are available concerning the feasibility and efficacy of this strategy for systemic lymphoma relapsing in the central nervous system. We, therefore, we performed an international multicenter retrospective study of patients with a central nervous system recurrence of systemic lymphoma to assess the outcome of these patients in the era of stem cell transplantation. We collected clinical and treatment data on patients with a first central nervous system recurrence of systemic lymphoma treated between 2000 and 2010 in one of five centers in four countries. Patient-and treatment-related factors were analyzed and compared descriptively. Primary outcome measures were overall survival and percentage of patients transplanted. We identified 92 patients, with a median age of 59 years and a median Eastern Cooperative Oncology Group/World Health Organization performance status of 2, of whom 76% had diffuse large B-cell histology. The majority (79%) of these patients were treated with systemic chemotherapy with or without intravenous rituximab. Twenty-seven patients (29%) were transplanted; age and insufficient response to induction chemotherapy were the main reasons for not being transplanted in the remaining 65 patients. The median overall survival was 7 months (95% confidence interval 2.6-11.4), being 8 months (95% confidence interval 3.8-5.2) for patients ≤ 65 years old. The 1-year survival rate was 34.8%; of the 27 transplanted patients 62% survived more than 1 year. The Memorial Sloan Kettering Prognostic Index for primary central nervous system lymphoma was prognostic for both undergoing transplantation and survival. In conclusion, despite the availability of autologous stem cell transplantation for patients with central nervous system progression or relapse of systemic lymphoma, prognosis is still poor. Longterm survival is, however, possible and more likely in patients able to undergo stem cell transplantation.Central nervous system recurrence of systemic lymphoma in the era of stem cell transplantation -an International Primary Central Nervous System Lymphoma Study Group project

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Section: Discussionmentioning

confidence: 99%

Central nervous system recurrence of systemic lymphoma in the era of stem cell transplantation - an International Primary Central Nervous System Lymphoma Study Group project

et al. 2012

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“…Few studies have reported on the effects of regimens incorporating high-dose intravenous MTX in patients with PCNSL or secondary CNS involvement [5,6,7]. However, no studies have been performed in patients who initially presented with systemic DLBCL with concurrent CNS involvement.…”

Section: Discussionmentioning

confidence: 99%

Pilot Trial of Systemic Methotrexate plus R-CHOP Regimen with Intrathecal Methotrexate for Simultaneous Central Nervous System and Systemic Diffuse Large B Cell Lymphoma

Yoo

Lee²,

Lim³

et al. 2014

Acta Haematol

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Background: The simultaneous presentation of systemic diffuse large B cell lymphoma (DLBCL) with central nervous system (CNS) disease is not well controlled by either R-CHOP or systemic methotrexate (MTX) alone. Methods: We conducted a pilot trial with 6 patients who were initially diagnosed with systemic DLBCL with CNS involvement. Patients were treated with a systemic MTX plus R-CHOP regimen. Results: The overall response rate was 4/6 (66.7%). The CNS response rate and systemic response rate were 4/6 (66.7%) and 5/6 (83.3%), respectively. The median response duration of the 4 patients with complete remission at completion was 25.5 months, and the median survival of all patients was 25.1 months. CNS lesions progressed in all relapsed and refractory patients, while systemic disease progression was observed in 1 patient. No fatal hematologic adverse effects, hepatotoxicity or nephrotoxicity were observed. Conclusions: The dose of systemic MTX (1∼1.5 g/m²) or dose intensity (4-week interval in 4 patients) used in this trial was considered insufficient. Therefore, the dose of MTX or interval of each chemotherapy cycle should be modified in future trials to control CNS disease involved with DLBCL. © 2014 S. Karger AG, Basel

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“…The HDMTX/IFO combination proved tolerable and highly active with a response rate of 90% in a pilot study with 20 patients. 25 Intrathecal therapy with liposomal AraC was added to the present protocol based on its higher effectiveness compared to conventional i.th. cytarabine in patients with lymphomatous meningitis in terms of tumor clearance rate, time to neurological progression, and survival, as well as longer half-life allowing longer administration intervals.…”

Section: Discussionmentioning

confidence: 99%

Phase II study of central nervous system (CNS)-directed chemotherapy including high-dose chemotherapy with autologous stem cell transplantation for CNS relapse of aggressive lymphomas

et al. 2012

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The prognosis of patients with central nervous system relapse of aggressive lymphoma is very poor with no therapy established so far. In a prospective multicenter phase II study, we evaluated a potentially curative chemotherapy-only regimen in these patients. Phase II study of central nervous system (CNS)-directed chemotherapy including high-dose chemotherapy with autologous stem cell transplantation for CNS relapse of aggressive lymphomas

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Systemic high-dose methotrexate plus ifosfamide is highly effective for central nervous system (CNS) involvement of lymphoma

Cited by 17 publications

References 32 publications

Central nervous system recurrence of systemic lymphoma in the era of stem cell transplantation - an International Primary Central Nervous System Lymphoma Study Group project

Central nervous system recurrence of systemic lymphoma in the era of stem cell transplantation - an International Primary Central Nervous System Lymphoma Study Group project

Pilot Trial of Systemic Methotrexate plus R-CHOP Regimen with Intrathecal Methotrexate for Simultaneous Central Nervous System and Systemic Diffuse Large B Cell Lymphoma

Phase II study of central nervous system (CNS)-directed chemotherapy including high-dose chemotherapy with autologous stem cell transplantation for CNS relapse of aggressive lymphomas

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