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Treatment of Primary Central Nervous System Lymphoma With High-Dose Methotrexate and Radiotherapy in Hiv-Negative Patients Pubmed



Jalaeikhoo H1 ; Yekaninejad MS2 ; Hajizamani S3 ; Rahim F4 ; Ahmadzadeh A5 ; Keyhani M6 ; Sadeghi Hariri B7 ; Saki N5
Authors
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Authors Affiliations
  1. 1. AJA cancer research center (ACRC) AJA University of Medical Sciences, Tehran, Iran
  2. 2. Department of epidemiology and Biostatics, School of public health, Tehran University of Medical Science, Tehran, Iran
  3. 3. Diagnostic Laboratory Sciences and Technology Research Center, School of Paramedical Sciences, Shiraz University of Medical Sciences, Shiraz, Iran
  4. 4. Health Research Institute, Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  5. 5. Health research institute, Research Center of Thalassemia and Hemoglobinopathy, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran
  6. 6. Hematology and Oncology Research Center, Vali-Asr Hospital, Tehran University of Medical Sciences, Tehran, Iran
  7. 7. Arad Hospital, Tehran, Iran

Source: Archives of Iranian Medicine Published:2015


Abstract

Background: We assessed the outcome of high-dose methotrexate (HD-MTX) chemotherapy with or without radiotherapy (RT) in primary central nervous system lymphoma (PCNSL) patients. Methods: Fifty-one HIV-negative patients with an average age of 50.3 years were treated with chemotherapy regimen included 2500 mg/m2MTX with Leucovorin rescue and 1.4mg/m2 vincristine (day two), which was administered every other week for 6 weeks. Only the patients who were younger than 60 years received RT. All patients received two cycles of 3000 mg/m2 cytarabine at the end of the treatment for two successive days. Results: Diffuse large B-cell lymphoma was the most common histologic subtype (90.2%), and twenty-six (51.0%) patients had multiple brain lesions. The median survival of patients who were younger than 60 years was 37 months. For patients who were older than 60 years, the median survival was 20 months. The median survival of men and women were 30 and 34 months, respectively. There was no significant difference in survival of patients in terms of age and sex. Overall, sixteen patients (31%) out of fifty-one patients died, five of them were older than 60 years and eleven were younger than 60-year. Twenty-five (49%) of all patients experienced relapse, and 10 (40%) of them died after rechemotherapy. Conclusions: The base of our chemotherapy regimen was HD-MTX as the regular doses of MTX cannot penetrate the blood brain barrier (BBB). Our results indicated that the combination of HD-MTX with RT may not influence the outcome of PCNSL; thus, RT cannot be the first line therapy. © 2015, Academy of Medical Sciences of I.R. Iran. All rights reserved.