High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma

Matthias Holdhoff, Prakash Ambady, Ahmed Abdelaziz, Guneet Sarai, David Bonekamp, Jaishri Blakeley, Stuart A. Grossman, Xiaobu Ye

Research output: Contribution to journalArticlepeer-review

100 Scopus citations


Objective: To evaluate the efficacy of rituximab (R) when added to high-dose methotrexate (HDMTX) in patients with newly diagnosed immunocompetent primary CNS lymphomas (PCNSLs). Methods: Immunocompetent adults with newly diagnosed PCNSL treated at The Johns Hopkins Hospital between 1995 and 2012 were investigated. From 1995 to 2008, patients received HD-MTX monotherapy (8 g/m2 initially every 2 weeks and after complete response [CR] monthly to complete 12 months of therapy). From 2008 to 2012, patients received the same HD-MTX with rituximab (375 mg/m2) with each HD-MTX treatment. CR rates and median overall and progression-free survival were analyzed for each patient cohort in this single-institution, retrospective study. Results: A total of 81 patients were identified: 54 received HD-MTX (median age 66 years) while 27 received HD-MTX/R (median age 65 years). CR rates were 36% in the HD-MTX cohort and 73% in the HD-MTX/R cohort (p = 0.0145). Median progression-free survival was 4.5 months in the HD-MTX cohort and 26.7 months in the HD-MTX/R cohort (p = 0.003). Median overall survival was 16.3 months in the HD-MTX cohort and has not yet been reached in the HD-MTX/R cohort (p = 0.01). Conclusions: The addition of rituximab to HD-MTX appears to improve CR rates as well as overall and progression-free survival in patients with newly diagnosed PCNSL. Comparisons of long-term survival in the 2 cohorts await further maturation of the data. Classification of evidence: This study provides Class III evidence that in immunocompetent patients with PCNSL, HD-MTX plus rituximab compared with HD-MTX alone improves CR and overall survival rates.

Original languageEnglish (US)
Pages (from-to)235-239
Number of pages5
Issue number3
StatePublished - Jul 15 2014
Externally publishedYes

ASJC Scopus subject areas

  • Clinical Neurology


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