Recurrent lymphomatous meningitis treated with intra-CSF rituximab and liposomal ara-C.
BACKGROUND
The most frequent central nervous system complication of systemic non-Hodgkin's lymphoma (NHL) is lymphomatous meningitis (LM).


OBJECTIVE
A clinical series to test the feasibility of combining intra-CSF liposomal ara-C and rituximab for the treatment of recurrent LM.


METHODS
Clinical series of 14 patients with CSF positive lymphomatous meningitis.


METHODS
Tertiary-care university medical center.


RESULTS
Fourteen patients with recurrent, cytologically positive lymphomatous meningitis were treated. All 14 received liposomal ara-C and rituximab utilizing an Ommaya reservoir. Six patients also received involved-field radiotherapy (brain only two patients; brain and spine two patients; spine only two patients). Best response to treatment included 10 partial responses and four with progressive disease. Estimated median duration of response was 4.0 months (range 1-6 months). Survival ranged from 1.5 to 7 months with an estimated median of 5 months, four patients remain alive and continue to be followed. Cause of death was progressive neurological disease in 7, systemic disease in 1, and combined systemic and neurological disease in 2 patients.


CONCLUSIONS
The combination of intra-CSF liposomal ara-C and rituximab administered in this schedule appears to have no additive toxicity and has modest palliative activity in patients with recurrent LM.
Chamberlain
Marc C
MC
Department of Neurology, Division of Neuro-Oncology, University of Washington, Fred Hutchinson Cancer Research Center Seattle Cancer Care Alliance, 825 Eastlake Avenue E, Seattle, WA 98109, USA. chambemc@u.washington.edu
Johnston
Sandra K
SK
Van Horn
Alixis
A
Glantz
Michael J
MJ
D000328:Adult; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000008:administration & dosage*; D003131:Combined Modality Therapy / Q000379:methods; D003561:Cytarabine / Q000008:administration & dosage*; D004333:Drug Administration Routes; D016503:Drug Delivery Systems; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy*; D008297:Male; D008581:Meningitis / Q000134:cerebrospinal fluid / Q000150:complications / Q000188:drug therapy*; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy*; D010743:Phospholipids / Q000627:therapeutic use; D000069283:Rituximab; D016019:Survival Analysis
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D010743:Phospholipids; C050797:liposom; D003561:Cytarabine; D000069283:Rituximab