© 2000 by Society
© 2000 by the Society forNeuro-Oncology
High-dose methotrexate for primary CNS lymphoma in the elderly
Department of Medical Oncology and ClinicalHaematology, Royal Melbourne Hospital, Parkville, Victoria, Australia 3050(S.N., M.A.R.); Department of Medical Oncology andClinical Haematology, Royal Children's Hospital, Parkville, Victoria,Australia 3050 (D.A); and Austin and RepatriationMedical Centre, Heidelberg, Victoria, Australia 3181 (L.C.)
1 Address correspondence and reprint requests to Siobhan Ng, M.D., Department ofMedical Oncology and Clinical Haematology, Royal Melbourne Hospital,Parkville, Victoria, Australia 3050.
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Abstract |
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Primary central nervous system lymphoma (PCNSL) in the immunocompetentpatient reaches a peak incidence in the sixth and seventh decades of life.This retrospective study reviewed the efficacy and tolerability of high-dosemethotrexate (HDMTX) in an elderly patient population. Between May 1995 andSeptember 1998, ten consecutive elderly patients with histologically provenPCNSL were treated with HDMTX. The median age was 72.5 years and eightpatients (80%) were older than 70 years. HDMTX was well tolerated with noepisodes of grade 4 toxicity nor febrile neutropenia. Toxicity included grade3 nausea (1), grade 2 mucositis (2), and grade 2 asymptomatic elevation ofliver transaminases (2). Grade 1 toxicity occurred in three patients withnausea, diarrhea, and mild reversible elevation in serum creatinine in onepatient each. Six patients had a complete response and three patients achieveda partial response, giving an overall response rate of 90% (95% confidenceinterval, 56%-100%). The median overall survival for the cohort was 36 months(range 4-43 months). In summary, HDMTX is well tolerated in thiselderly population with PCNSL and achieves response rates and median survivalcomparable with other chemotherapy or radiotherapy regimens.
Received August 31, 1999; Accepted October 18, 1999
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