Cancer Research Lab

Treatment with high-dose methotrexate leads to complete response in a substantial proportion of patients with primary CNS lymphoma, according to long-term follow-up of a phase II trial.

Dr. Tracy T. Batchelor, at Massachusetts General Hospital in Boston, and colleagues treated 25 HIV-negative adult patients with newly diagnosed primary CNS lymphoma with IV methotrexate 8 g/m² every 2 weeks for up to 8 weeks or until a complete response was achieved. Complete responders were given two additional consolidation cycles of methotrexate and 11 maintenance cycles.

Twelve patients (52%) achieved a complete response to methotrexate induction, the authors report in the January 29 issue of Neurology, and five (20%) remain disease free after a median follow-up of 6.8 years.

Fourteen patients have died: 11 patients from progressive disease or of unknown cause, two from cardiac disease, and one from septic arthritis.

Multiple salvage regimens were used following relapse, including brain irradiation in 13 patients. Median overall survival was 55.4 months.

“High-dose methotrexate alone or in combination with other therapies is the most effective treatment available for primary CNS lymphoma,” Dr. Batchelor’s team concludes.