title: Concurrent administration of intravenous systemic and intravitreal methotrexate for intraocular lymphoma with central nervous system involvement.
abstract: Intraocular lymphoma (IOL) is rare lymphoma that frequently infiltrates the central nervous system (CNS). An optimal treatment has not been established, and its prognosis is quite poor. We treated three IOL patients with CNS involvement by concurrent administration of intravenous and intravitreal methotrexate (MTX) injection. The intraocular lesion responded in all patients. One patient achieved complete response (CR), whereas the other 2 patients were in partial response for CNS lesion, added whole brain radiation and achieved CR. In 3 eyes of 2 patients, an intravitreal MTX injection (vMTX) was administered 2 h after a systemic MTX injection (sMTX) and the intravitreal MTX concentration was measured twice: 2 h after sMTX and 24 h after vMTX. The half-life of MTX in the vitreous fluid was estimated to be 12.4-21.5 h by assuming the first-order elimination kinetics. Although the concentration was still high 24 h after vMTX (69.94-82.89 muM), there were no ocular complications. The serum MTX concentration was not influenced by adding vMTX to sMTX. Grade 3 adverse event, leukocytopenia, was observed in only 1 patient. No grade 4 event was observed. Although further evaluation is required, concurrent sMTX and vMTX may be effective for IOL with CNS involvement.
authors.affiliation: Department of Hematology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, Japan.
authors.forename: Yusuke
authors.initials: Y
authors.lastname: Nakauchi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Takase
authors.forename: Sunao
authors.initials: S
authors.lastname: Sugita
authors.forename: Manabu
authors.initials: M
authors.lastname: Mochizuki
authors.forename: Satoko
authors.initials: S
authors.lastname: Shibata
authors.forename: Yasuyoshi
authors.initials: Y
authors.lastname: Ishiwata
authors.forename: Yuka
authors.initials: Y
authors.lastname: Shibuya
authors.forename: Masato
authors.initials: M
authors.lastname: Yasuhara
authors.forename: Osamu
authors.initials: O
authors.lastname: Miura
authors.forename: Ayako
authors.initials: A
authors.lastname: Arai
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic; D016543:Central Nervous System Neoplasms / Q000188:drug therapy; D004333:Drug Administration Routes; D005134:Eye Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology; D008727:Methotrexate / Q000008:administration & dosage*; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate
references.citation: Clin Cancer Res. 2003 Feb;9(2):711-5
references.pmid: 12576439
references.citation: Graefes Arch Clin Exp Ophthalmol. 2004 Nov;242(11):901-13
references.pmid: 15565454
references.citation: J Clin Oncol. 2000 Sep;18(17):3144-50
references.pmid: 10963643
references.citation: Cancer Control. 1998 Jul;5(4):317-325
references.pmid: 10761081
references.citation: Br J Ophthalmol. 2008 Mar;92(3):383-8
references.pmid: 18303160
references.citation: Br J Haematol. 2004 Jul;126(2):202-8
references.pmid: 15238140
references.citation: Neurology. 2008 Oct 21;71(17):1355-60
references.pmid: 18936428
references.citation: Trans Am Ophthalmol Soc. 2003;101:275-92
references.pmid: 14971583
references.citation: Br J Ophthalmol. 1999 Apr;83(4):448-51
references.pmid: 10434868
references.citation: Jpn J Ophthalmol. 2009 May;53(3):209-14
references.pmid: 19484437
references.citation: Ann Oncol. 2002 Apr;13(4):531-8
references.pmid: 12056702
references.citation: Bull Soc Belge Ophtalmol. 2001;(279):91-5
references.pmid: 11344720
references.citation: Arch Ophthalmol. 1997 Sep;115(9):1157-60
references.pmid: 9298057
references.citation: Am J Clin Pathol. 1997 Sep;108(3):295-301
references.pmid: 9291458