title: Primary meningeal CNS lymphoma treated with intra-arterial chemotherapy and blood-brain barrier disruption.
abstract: Diffuse large B-cell lymphoma of the meninges is a particularly rare form of primary CNS lymphoma. We report a case of a 63-year-old woman found to have primary meningeal lymphoma (PML) with dural and leptomeningeal involvement whom we treated with multiple cycles of intra-arterial (IA) methotrexate, intravenous (IV) etoposide phosphate, and IV cyclophosphamide after reversible osmotic blood-brain barrier disruption (BBBD). Improvement was evident on gadolinium-enhanced brain MRI one month into therapy. At 67 months post-diagnosis there is no evidence of CNS disease. After completing her therapy regimen, she remained disease-free for 34 months, when stage IV diffuse large B-cell lymphoma was discovered in her left adrenal gland and right thigh. Following six cycles of rituximab and CHOP treatment, she is presently in complete remission. IA methotrexate and reversible osmotic BBBD without radiation therapy may be an effective therapy for treating PML.
authors.affiliation: College of Medicine, The Ohio State University Medical Center, 370 West 9th Ave, Columbus, OH 43210, USA. marcus.macnealy@osumc.edu
authors.forename: Marcus W C
authors.initials: MW
authors.lastname: Macnealy
authors.forename: Herbert B
authors.initials: HB
authors.lastname: Newton
authors.forename: John M
authors.initials: JM
authors.lastname: McGregor
authors.forename: Susan D
authors.initials: SD
authors.lastname: Bell
authors.forename: Abhik
authors.initials: A
authors.lastname: Ray Chaudhury
authors.forename: H Wayne
authors.initials: HW
authors.lastname: Slone
authors.forename: Eric C
authors.initials: EC
authors.lastname: Bourekas