title: Retrospective study of pemetrexed as salvage therapy for central nervous system lymphoma.
abstract: There is currently no standard therapy for recurrent or chemotherapy-refractory central nervous system lymphoma (CNSL). Pemetrexed has been reported to have activity in patients with primary CNSL (PCNSL). The use of pemetrexed in secondary CNS lymphoma (SCNSL) has not previously been reported. Here we retrospectively review the outcomes and toxicities of standard and modified doses of pemetrexed as salvage therapy in 18 PCNSL and 12 SCNSL patients. The overall response rate for PCNSL patients was 64.7 %, all of whom achieved a complete response (CR). The median progression-free survival (PFS) was 5.8 months. For the SCNSL patients, RR was 58.3 % with 2 CR (16.7 %); the median PFS was 2.5 months. Grade ≥3 adverse events included leukopenia in 5 patients (16.7 %), neutropenia in 1 patient (3.3 %), and fatigue in 3 patients (10.0 %). 3 patients died while on treatment, 2 due to infections and 1 due to pulmonary embolism. Our results indicate that pemetrexed has activity as salvage therapy in recurrent PCNSL, even with modified dosing, but outcomes trend towards less favorable in SCNSL.
authors.affiliation: Department of Neuro-Oncology, Beijing Sanbo Brain Hospital, Capital Medical University, Beijing, China.
authors.forename: Jun-Ping
authors.initials: JP
authors.lastname: Zhang
authors.forename: Eudocia Q
authors.initials: EQ
authors.lastname: Lee
authors.forename: Lakshmi
authors.initials: L
authors.lastname: Nayak
authors.forename: Lisa
authors.initials: L
authors.lastname: Doherty
authors.forename: Santosh
authors.initials: S
authors.lastname: Kesari
authors.forename: Alona
authors.initials: A
authors.lastname: Muzikansky
authors.forename: Andrew D
authors.initials: AD
authors.lastname: Norden
authors.forename: Huichao
authors.initials: H
authors.lastname: Chen
authors.forename: Patrick Y
authors.initials: PY
authors.lastname: Wen
authors.forename: Jan
authors.initials: J
authors.lastname: Drappatz
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000473:pathology; D005260:Female; D005500:Follow-Up Studies; D005971:Glutamates / Q000627:therapeutic use*; D006147:Guanine / Q000031:analogs & derivatives* / Q000627:therapeutic use; D006801:Humans; D016393:Lymphoma, B-Cell / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000188:drug therapy* / Q000473:pathology; D009367:Neoplasm Staging; D000068437:Pemetrexed; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D005971:Glutamates; D000068437:Pemetrexed; D006147:Guanine