Immunochemotherapy using rituximab (RTX) and high-dose methotrexate (HD-MTX): an evaluation of the addition of RTX to HD-MTX in recurrent primary central nervous system lymphoma (PCNSL)

Abstract

Background

There is increasing evidence that MTX-based chemotherapy is superior to HD-MTX alone. Rituximab (RTX) is effective in a variety of B-cell lymphomas and may enter the brain. The purpose of this study is to evaluate the addition of RTX to HD-MTX in recurrent primary central nervous system lymphoma (PCNSL).

Methods

Patients diagnosed with recurrent PCNSL at our institution between 2004 and 2009 were treated with HD-MTX (3.5–5.5 g/m²) every 2 weeks. From 2010, RTX (375 mg/m²) was administered every 2 weeks along with HD-MTX.

Results

Fifteen recurrences in 10 patients were treated with HD-MTX alone (MTX group). Another 15 recurrences in 10 patients were treated with RTX and HD-MTX (RTX group). In 13 (86.6%) of the 15 recurrences in both groups the pre-planned chemotherapy cycles were completed. In the MTX group, 10/15 (66.6%) recurrences achieved a complete response (CR/CRu), 2/15 (13.3%) recurrences achieved a partial response (PR) and 3/15 (20%) recurrences had progressive disease (PD). In the RTX group, the CR/CRu, PR and PD rates were the same as that in the MTX group. The median time to tumor progression (mTTP) was 9.1 months (range, 1.4–120.9 months) in the MTX group and 7.8 months (range, 0.9–52.3 months) in the RTX group. We found no significant difference in mTTP (9.1 vs. 7.8 months, HR 1.02, 95% CI 0.48–2.18, P = 0.94) between the two groups. All treatment-related toxicities were manageable without any severe events.

Conclusions

The addition of RTX to HD-MTX may not be a promising strategy for recurrent PCNSL. A future study with a larger sample size, longer follow-up, or different RTX dosing/schedule is warranted.

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