Treatment > Monoclonal Antibodies

Meeting Abstract

Rituximab as an alternative treatment for primary central nervous system lymphoma (PCNSL)

A. Torres-Trejo, J. L. Mabold, F. S. Lieberman, S. C. Schold

University of Pittsburgh Cancer Institute, Pittsburgh, PA

PCNSL is predominantly a B-cell malignant lymphoma.
Despite its responsiveness to standard treatment consisting of whole brain radiation therapy (WBRT), corticosteroids, and high dose methotrexate (HDMTX)-based chemotherapy, there is a high relapse rate.
Once this occurs, treatment options are limited.
Rituximab is an anti-CD20 monoclonal antibody that has been used to treat B-cell Non-Hodgkin Lymphoma (NHL).
There is little experience using this agent to treat PCNSL.
We report our experience using Rituximab in 4 patients.
A: 44 yo man diagnosed in 4/99 who had WBRT and HDMTX-based chemotherapy with a magnetic resonance imaging (MRI) response, had a recurrence and received HDMTX with good response.
He again recurred and was treated with Temodar without response, had HDMTX again with response but again recurred on 01/02 at which time Rituximab was initiated with dramatic MRI response and stability for almost a year, until 12/02 when another recurrence occurred.
B: 51 yo female diagnosed in 9/02 received HDMTX without MRI response, had WBRT with complete MRI response.
Rituximab was initiated on 11/19/02 and the patient has stabilized clinically.
C: 60 yo man diagnosed in 06/02 initially had HDMTX plus vincristine and procarbazine, complicated by thrombocytopenia, intracranial hemorrhage and deep venous thrombosis followed by methotrexate and vincristine with good imaging response.
MTX could not be continued because of inadequate renal function and Rituximab was initiated on 09/02.
To date the patient has been stable clinically and by MRI.
D: 43 yo male diagnosed in 3/02 received HDMT with partial MRI response.
HDMTX was not re-started because of inadequate renal function so Rituximab was initiated on 10/02 with MRI improvement that has persisted.
All of these patients have had an excellent tolerability profile to Rituximab with no major side effects.
We believe that Rituximab can be used as an alternative therapy when patients do not respond or do not tolerate standard treatment, inducing MRI responses.
Further studies need to be performed to treat PCNSL with Rituximab alone or in combination with chemotherapy and low dose WBRT or without radiation.

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