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 journalArticle

59 Citations (Scopus)

Abstract

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
JournalNeurology
Volume83
Issue number3
DOIs
StatePublished - Jul 15 2014
Externally publishedYes

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Methotrexate
Lymphoma
Disease-Free Survival
Survival
Rituximab
Central Nervous System
Dose
Cohort
Survival Rate
Retrospective Studies
Therapeutics
Progression

ASJC Scopus subject areas

  • Clinical Neurology
  • Arts and Humanities (miscellaneous)

Cite this

Holdhoff, M., Ambady, P., Abdelaziz, A., Sarai, G., Bonekamp, D., Blakeley, J., ... Ye, X. (2014). High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma. Neurology, 83(3), 235-239. https://doi.org/10.1212/WNL.0000000000000593

High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma. / Holdhoff, Matthias; Ambady, Prakash; Abdelaziz, Ahmed; Sarai, Guneet; Bonekamp, David; Blakeley, Jaishri; Grossman, Stuart A.; Ye, Xiaobu.

In: Neurology, Vol. 83, No. 3, 15.07.2014, p. 235-239.

Research output: Contribution to journalArticle

Holdhoff, M, Ambady, P, Abdelaziz, A, Sarai, G, Bonekamp, D, Blakeley, J, Grossman, SA & Ye, X 2014, 'High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma', Neurology, vol. 83, no. 3, pp. 235-239. https://doi.org/10.1212/WNL.0000000000000593
Holdhoff, Matthias ; Ambady, Prakash ; Abdelaziz, Ahmed ; Sarai, Guneet ; Bonekamp, David ; Blakeley, Jaishri ; Grossman, Stuart A. ; Ye, Xiaobu. / High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma. In: Neurology. 2014 ; Vol. 83, No. 3. pp. 235-239.
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abstract = "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.",
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AU - Holdhoff, Matthias

AU - Ambady, Prakash

AU - Abdelaziz, Ahmed

AU - Sarai, Guneet

AU - Bonekamp, David

AU - Blakeley, Jaishri

AU - Grossman, Stuart A.

AU - Ye, Xiaobu

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AB - 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.

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