A study published in The Lancet suggests that adding high-dose cytarabine to standard methotrexate treatment of primary central nervous system (CNS) lymphomas results in a significantly higher remission rate than methotrexate alone.
Patients
The study involved 79 adults with non-Hodgkin lymphoma confined to the central nervous system (CNS), cranial nerves, or eyes.
Researchers
This was a Phase II trial carried out by researchers at San Raffaele Scientific Institute in Milan, Italy, and led by Andres J.M. Ferreri, M.D.
Results
Complete remission rates after a median follow-up of 30 months:
- Among patients who got methotrexate plus cytarabine: 46 percent
- Among patients who got methotrexate: 19 percent
However, 92 percent of those patients who got both drugs experienced grade 3 or 4 hematological toxicity, compared to only 15 percent for the patients receiving only the methotrexate.
NB: Treatment of virtually all patients included whole-brain irradiation.
Conclusion
According to the authors, "The addition of high-dose cytarabine to high-dose methotrexate is associated with a remarkable outcome benefit in patients with primary central nervous system lymphoma. This combination could be used as an upfront approach in patients aged 75 years and younger and with adequate hepatic and renal function, with appropriate antimicrobial prophylaxis."
