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Ifosfamide for
intraocular lymphoma
E. Thiel, K. Jahnke, T. Wagner, N. E. Bechrakis, S. E. Coupland, A.
Schmittel, L. Fischer, M. H. Foerster, A. Korfel
Charité-Universitätsmedizin Berlin, Campus Benjamin Franklin,
Berlin, Germany; University of Lübeck, Lübeck, Germany
Background.
Intraocular lymphoma (IOL) occurs as a manifestation of a
primary central nervous system lymphoma (PCNSL) or as ocular involvement of a
systemic lymphoma.
The treatment of IOL has not yet been defined, since the data has been limited
to small, usually retrospective treatment series or case reports.
CNS relapse is the rule after local treatment modalities.
Ifosfamide is administered intravenously (IV) or orally (PO) as the main
metabolite of trofosfamide.
Its penetration into the eye has never been evaluated but is assumed based on
its ability to penetrate the CNS.
Methods.
We treated 4 patients (pts) with bilateral IOL confirmed by
vitrectomy and/or chorioretinal biopsy.
Patient (pt) 1, a 83-year-old woman with newly diagnosed primary IOL and
multiple comorbidities, refused radiotherapy (RT).
Pt 2, a 46-year-old man, had a PCNSL resistant to 3 chemotherapy regimens and
relapsed after RT in both eyes.
Pt 3, a 77-year-old man, had secondary IOL due to newly diagnosed
immunocytoma.
Pt 4, a 52-year-old man, had an intraocular relapse of PCNSL after high-dose
methotrexate and RT.
Pts 1 and 2 received either 150 mg or 400 mg/day of trofosfamide PO on days 1-5
followed by a five-day drug-free interval.
Pts 3 and 4 received either 2,000 or 1,500 mg/m2/day of ifosfamide IV
days 1-3.
Concentrations of ifosfamide and its active metabolite, 4-hydroxy-ifosfamide,
were measured in the serum and anterior chamber of the eye in pt 4.
Results.
According to fundoscopy, pts 1-3 achieved complete remission at
7+, 18 and 3+ months, which was accompanied by a significant increase in visual
acuity (VA).
Pt 4, who is still under treatment, had a partial remission after one cycle with
VA normalization.
The 4-hydroxy-ifosfamide concentration in the anterior chamber of the eye was
2.39 µmol/l (54 % of the corresponding serum concentration) directly after the
2-hour infusion.
No significant therapy-related side effects were noted in all pts.
Conclusions.
Ifosfamide seems to be active in IOL with a favorable side
effect profile.
Trofosfamide can be administered on an outpatient basis. The eye was
significantly penetrated by 4-hydroxy-ifosfamide.
Copyright 2004 American Society of Clinical Oncology All rights
reserved worldwide.
Source: http://www.asco.org/ac/1,1003,_12-002636-00_18-0026-00_19-001580,00.asp
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