title: Rituximab therapy for CNS lymphomas: targeting the leptomeningeal compartment.
abstract: Most lymphomas that involve the central nervous system are B-cell neoplasms that express the cell surface molecule CD20. After intravenous administration, rituximab can be reproducibly measured in the cerebrospinal fluid (CSF) in patients with primary central nervous system lymphoma; however, the CSF levels of rituximab are approximately 0.1% of serum levels associated with therapeutic activity in patients with systemic non-Hodgkin lymphoma. Because lymphomatous meningitis is a frequent complication of non-Hodgkin lymphoma, we have conducted an analysis of the safety and pharmacokinetics of direct intrathecal administration of rituximab using cynomolgus monkeys. No significant acute or delayed toxicity, neurologic or otherwise, was detected. Pharmacokinetic analysis suggests that drug clearance from the CSF is biphasic, with a terminal half-life of 4.96 hours. A phase 1 study to investigate the safety and pharmacokinetics of intrathecal rituximab in patients with recurrent lymphomatous meningitis will be implemented based on these findings.
authors.affiliation: Division of Hematology/Oncology, Comprehensive Cancer Center, Cancer Research Institute, Department of Neurosurgery, UCSF, San Francisco, CA 94143, USA. jamesr@medicine.ucsf.edu
authors.forename: James L
authors.initials: JL
authors.lastname: Rubenstein
authors.forename: Dan
authors.initials: D
authors.lastname: Combs
authors.forename: Jay
authors.initials: J
authors.lastname: Rosenberg
authors.forename: Arthur
authors.initials: A
authors.lastname: Levy
authors.forename: Michael
authors.initials: M
authors.lastname: McDermott
authors.forename: Lloyd
authors.initials: L
authors.lastname: Damon
authors.forename: Robert
authors.initials: R
authors.lastname: Ignoffo
authors.forename: Kenneth
authors.initials: K
authors.lastname: Aldape
authors.forename: Arthur
authors.initials: A
authors.lastname: Shen
authors.forename: Dana
authors.initials: D
authors.lastname: Lee
authors.forename: Antonio
authors.initials: A
authors.lastname: Grillo-Lopez
authors.forename: Marc A
authors.initials: MA
authors.lastname: Shuman
mesh_terms: D000818:Animals; D000911:Antibodies, Monoclonal / Q000008:administration & dosage* / Q000493:pharmacokinetics* / Q000633:toxicity; D058846:Antibodies, Monoclonal, Murine-Derived; D019540:Area Under Curve; D016543:Central Nervous System Neoplasms / Q000188:drug therapy*; D004353:Drug Evaluation, Preclinical; D005260:Female; D006207:Half-Life; D007278:Injections, Spinal; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008252:Macaca fascicularis; D008657:Metabolic Clearance Rate; D000069283:Rituximab
chemical_list: D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000069283:Rituximab