Rituximab significantly improves complete response rate in patients with primary CNS lymphoma

Abstract

Rituximab improves outcome for patients with systemic diffuse large B-cell lymphoma (DLBCL) and has therefore become a standard component of the treatment of this disease. However, it is unclear whether rituximab is efficacious in patients with primary CNS lymphoma (PCNSL), a rare DLBCL variant, also. The purpose of this study was to evaluate the effect of rituximab on the complete response (CR) rate after chemotherapy with methotrexate (MTX) and ifosfamide (IFO) of patients with PCNSL. This is a retrospective, observational, single-center trial analyzing 36 consecutive patients with newly diagnosed, CD-20-positive PCNSL who were treated primarily with chemotherapy between March 2007 and December 2010. We compared 19 patients who were treated with MTX and IFO with 17 patients who were treated with the same regimen plus rituximab. The addition of rituximab to MTX and IFO was correlated with a significant increase in the CR rate (100.0 vs. 68.4 %, p = 0.02). Furthermore, six-month progression-free survival was significantly higher for the rituximab group (94.1 vs. 63.2 %, p = 0.04). Toxicity did not differ significantly between the groups. Our results indicate that rituximab might be efficacious in the treatment of PCNSL and support addition of this drug to current treatment protocols until data from randomized controlled trials becomes available. Immunochemotherapy with MTX, IFO, and rituximab seems to have excellent activity as induction chemotherapy and should be further tested in prospective trials.

Primary central nervous system lymphoma treated with high-dose methotrexate and rituximab: A single-institution experience

“…In one prospective single-arm study (16), patients received induction chemotherapy with an RTX, MTX, vincristine and procarbazine regimen, and achieved an ORR of 93% and a CRR of 78%. Another study investigated combined RTX, MTX and ifosfamide therapy, and found that the addition of RTX resulted in an improved CRR (100%) and 6-month PFS (PFS-6) rate (94%) compared with MTX and ifosfamide alone (CRR, 68%; PFS-6, 63%) (15). Two previous studies evaluated combined HD-MTX and RTX (14,24).…”

“…There is now increasing evidence that MTX-based polychemotherapy is superior to HD-MTX alone, for instance, when MTX is combined with HD-cytarabine (Ara-C) or ifosfamide (12,13). Furthermore, rituximab (RTX) is now frequently combined with single-agent HD-MTX or MTX-based polychemotherapy, based on observations that the addition of RTX results in improved response rates (14)(15)(16)(17)(18). The present study reports the experience of a single institution as a retrospective case series of 12 patients with newly diagnosed PCNSL treated with HD-MTX and RTX.…”

Successful Treatment of Elderly Diffuse Large B-Cell Lymphoma with Central Nervous System Recurrence by Rituximab, Ranimusutine, Ifosfamide, Procarbazine, Dexamethasone, and Etoposide Therapy

“…Bimbaum et al recently reported the benefits of rituximab in addition to MTX and IFO over MTX and IFO in 36 cases of primary CNS lymphoma in a retrospective analysis [6]. In prospective study, some investigators described promising response rate and survival in primary CNS lymphoma by multi-agent chemotherapy including rituximab as induction therapy [4, 5,7].…”

“…On the other hand, we did not use rituximab in the study [3]. Recently, regarding primary CNS lymphoma (PCNSL), intravenous rituximab in addition to combined chemotherapy has been accepted as the standard treatment strategy [4][5][6][7]. Furthermore, CNS recurrence of systemic DLBCL is usually premonitory symptom of systemic recurrence, therefore, administration of rituximab in the salvage therapy may be considered as prevention for systemic reoccurrence.…”

Treatment of Primary CNS Lymphoma

“…This may reflect the partially disrupted blood-brain barrier in PCNSL which may still allow the antibody reaching some of brain lymphoma cells. Series looking at the efficacy of rituximab when added to a MTX-based regimen suggest a certain activity in PCNSL which is associated with increased CR rates that may eventually translate into prolonged OS without adding significant toxicity [50,51]. analysis were predictive for response to temozolomide [54,55].…”