Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
Combination chemotherapy in the treatment of primary central nervous system and intraocular lymphoma (Meeting abstract).
Proc Annu Meet Am Soc Clin Oncol; 14:A306 1995. Unique Identifier : AIDSLINE ICDB/95613460 Stark-Vancs V; Setser A; Kohler D; Heiss J; Nussenblatt R; Whitcup S; deSmet M; Jaffe E; Solomon D; Patronas N; et al; NIH, Bethesda, MD 20892
Abstract:
Eleven patients (pts) with primary CNS non-Hodgkin's lymphoma, or primary intraocular lymphoma with CNS metastases, all HIV-, were treated on a protocol of combination chemotherapy. Nine pts were treated on a pilot study of iv high-dose methotrexate (MTX) with leucovorin rescue, vincristine, thiotepa, oral dexamethasone, and intra-Ommaya (IO) cytarabine (Proc ASCO 13:180, 1994). Two pts have been entered on a phase II study with the addition of IO MTX alternating with IO cytarabine. All pts had cytologic or histologic verification of malignant lymphoma prior to treatment; all were phenotypically B-cell lymphomas and all tested (n=7) were negative for the presence of Epstein-Barr virus. Four pts had involvement of the vitreous or retina; in 3 this was the presenting complaint. Ten pts had involvement of the brain parenchyma; 3 pts had 2 or more lesions. Involvement of the cerebral spinal fluid (CSF) was present by lumbar puncture in 4/11 pts and at insertion of an Ommaya reservoir in 7/11 pts. Nine pts were previously untreated but 2 had relapsed from whole brain radiotherapy (WBRT) at least 3 mo prior to treatment. All pts were treated to complete response (CR) or stable partial response (PR) + 2 cycles (median: 5). All pts had pharmacokinetic monitoring of serum and CSF MTX levels in each cycle. MTX was detected in the vitreous, CSF, and serum in 1 pt who underwent vitrectomy 625 hr after completing IV MTX. Of 49 cycles evaluable for toxicity, 4 were complicated by grade (gr) 1 or 2 renal toxicity which resolved; 3 by gr 4 neurotoxicity (seizures); 1 by gr 4 ileus. Only 3 pts experienced gr 3 or 4 neutropenia, requiring cytokines with subsequent cycles. Of 2 pts removed from study for toxicity, 1 had achieved CR (after 1 cycle) and 1 had a PR in the vitreous (after 4 cycles); both subsequently received RT. Of 11 pts entered on study, 8 achieved CR, 2 PR, 1 is too early to evaluate. Two pts who achieved CR relapsed locally and received RT; 1 died of disease progression. Both patients who achieved a PR are alive; 1 achieved a CR following ocular RT. For 9 pts who have completed therapy, median survival is 18+ mo, 3-15 mo after completing therapy. The phase II protocol incorporates neuropsychological testing, positron emission tomography, and magnetic resonance spectroscopy to prospectively determine possible interactions between this chemotherapy regimen and previous or salvage WBRT in the development of late neurotoxicity. No clinical evidence of late toxicity has yet been observed in pts on the pilot study who have received both treatments (n=3).
Keywords: Antineoplastic Agents, Combined/ADVERSE EFFECTS/*THERAPEUTIC USE Central Nervous System Neoplasms/*DRUG THERAPY Cytarabine/ADMINISTRATION & DOSAGE Dexamethasone/ADMINISTRATION & DOSAGE Eye Neoplasms/*DRUG THERAPY Human Leucovorin/ADMINISTRATION & DOSAGE Lymphoma, B-Cell/*DRUG THERAPY Methotrexate/ADMINISTRATION & DOSAGE/CEREBROSPINAL FLUID Thiotepa/ADMINISTRATION & DOSAGE Vincristine/ADMINISTRATION & DOSAGE ABSTRACT 951230
M95C3232
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Important note: Information in this article was accurate in 1995. The state of the art may have changed since the publication date.
