Treatment of diffuse large B‐cell lymphoma with secondary central nervous system involvement: encouraging efficacy using CNS‐penetrating R‐IDARAM chemotherapy

Abstract

Diffuse large B-cell lymphoma with secondary involvement of the central nervous system (SCNS-DLBCL) is a rare condition carrying a poor prognosis. No optimal therapeutic regimen has been identified. We retrospectively analysed 23 patients with SCNS-DLBCL treated with R-IDARAM (rituximab 375 mg/m(2) IV day 1; methotrexate 12·5 mg by intrathecal injection day 1; idarubicin 10 mg/m(2) /day IV days 1 and 2; dexamethasone 100 mg/day IV infusion over 12 h days 1-3; cytosine arabinoside 1000 mg/m(2) /day IV over 1 h days 1 and 2; and methotrexate 2000 mg/m(2) IV over 2 h day 3. Ten out of 23 (44%) patients had CNS involvement at initial presentation ('new disease'), 10/23 (44%) had relapsed disease and 3/23 (13%) had primary refractory disease. 14/23 (61%) of patients responded - 6 (26%) complete response, 8 (35%) partial response. Grade 3-4 haematological toxicity was seen in all cycles, with no grade 3-4 or long-term neurological toxicity. Median follow-up for surviving patients was 49 months. At 2 years, estimated progression-free survival (PFS) was 39% and overall survival (OS) was 52%. Encouraging outcomes were reported in patients with new disease, with 5-year estimated PFS of 50% and OS 75%. R-IDARAM is a well-tolerated regimen with encouraging efficacy in patients with SCNS-DLBCL, although patients with relapsed or refractory disease continue to fare poorly.

Treatment of secondary central nervous system lymphoma with intrathecal rituximab, high‐dose methotrexate, and R‐DHAP followed by autologous stem cell transplantation: results of the HOVON 80 phase 2 study

“…Transplantation was not planned for all patients, and only 5 patients received a transplant. The authors conclude that this regimen has an encouraging outcome in newly diagnosed SCNSL …”

Treatment of initial parenchymal central nervous system involvement in systemic aggressive B-cell lymphoma

“…In a second study with HD-MTX, rituximab, cytarabine and idarubicin (R-IDARAM) 4 out of 10 (40%) patients achieved a CR. Median OS of both studies was 25.1 months and more than 30 months, respectively [14,18]. In a pilot study with dose-adjusted EPOCH (etoposide, cyclophosphamide, doxorubicin, vincristine, prednisone) plus rituximab 8 out of 8 patients achieved a CR [15].…”

Treatment of newly diagnosed B-cell origin primary CNS lymphoma with systemic R-IDARAM chemotherapy and intrathecal immunochemotherapy

“…No further study was reported about the efficacy and safety of R-IDARAM on PCNSL patients with overall survival and progression free survival. In 2016, Maciocia P et al treated diffuse large B-cell lymphoma with secondary CNSL involvement which also showed encouraging efficacy and well tolerance [ 13 ]. This study evaluated the efficacy and safety of R-IDARAM chemotherapy and intrathecal immunochemotherapy in patients with PCNSL.…”