Concurrent administration of intravenous systemic and intravitreal methotrexate for intraocular lymphoma with central nervous system involvement.
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.
Nakauchi
Yusuke
Y
Department of Hematology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, Japan.
Takase
Hiroshi
H
Sugita
Sunao
S
Mochizuki
Manabu
M
Shibata
Satoko
S
Ishiwata
Yasuyoshi
Y
Shibuya
Yuka
Y
Yasuhara
Masato
M
Miura
Osamu
O
Arai
Ayako
A
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
D000964:Antimetabolites, Antineoplastic; D008727:Methotrexate
Clin Cancer Res. 2003 Feb;9(2):711-5
12576439
Graefes Arch Clin Exp Ophthalmol. 2004 Nov;242(11):901-13
15565454
J Clin Oncol. 2000 Sep;18(17):3144-50
10963643
Cancer Control. 1998 Jul;5(4):317-325
10761081
Br J Ophthalmol. 2008 Mar;92(3):383-8
18303160
Br J Haematol. 2004 Jul;126(2):202-8
15238140
Neurology. 2008 Oct 21;71(17):1355-60
18936428
Trans Am Ophthalmol Soc. 2003;101:275-92
14971583
Br J Ophthalmol. 1999 Apr;83(4):448-51
10434868
Jpn J Ophthalmol. 2009 May;53(3):209-14
19484437
Ann Oncol. 2002 Apr;13(4):531-8
12056702
Bull Soc Belge Ophtalmol. 2001;(279):91-5
11344720
Arch Ophthalmol. 1997 Sep;115(9):1157-60
9298057
Am J Clin Pathol. 1997 Sep;108(3):295-301
9291458