title: Combined treatment of rituximab, idarubicin, dexamethasone, cytarabine, methotrexate with radiotherapy for primary central nervous system lymphoma.
abstract: The overall response rates and long-term survival of primary central nervous system lymphoma (PCNSL) are still significantly inferior to the results achieved in similar subtypes of extranodal non-Hodgkin's lymphoma. It is clearly necessary to investigate new therapeutic methods on PCNSL. We encountered three patients histologically documented PCNSL as diffuse large B-cell lymphoma (DLBCL). They were treated with R-IDARAM which comprised rituximab, idarubicin, dexamethasone, cytarabine and methotrexate. Patient 1 received stereotactic brachytherapy (SBT) prior to chemotherapy performed with iodine-125 seeds (cumulative therapeutic dose 50 Gy). After six cycles of R-IDARAM at 3-weekly intervals, radiotherapy was applied at a dosage of 2000-4000 cGy in conventional schedule (180 or 200 cGy/day) to whole brain or spinal cord in all patients. Complete remission (CR) was achieved after first two cycles of R-IDARAM in all patients. All three patients remained in CR at the time of this report with a median duration of follow-up of 23 months (ranging from 13 to 41 months). Three patients have been alive for 41, 13, 16 months respectively until now. The patient with the longest survival time was the one given SBT prior to chemotherapy. This study suggests that R-IDARAM combining with radiotherapy maybe a high effective regimen in PCNSL patients especially those with primary central nervous system DLBCL. A comprehensive treatment combining internal radiotherapy by SBT, modified R-IDARAM and followed reduced external radiotherapy may be a new treatment concept for PCNSL with higher efficiency and lower toxicity.
authors.affiliation: Department of Hematology, Navy General Hospital of PLA, Beijing, China.
authors.forename: Defeng
authors.initials: D
authors.lastname: Zhao
authors.forename: Liren
authors.initials: L
authors.lastname: Qian
authors.forename: Jianliang
authors.initials: J
authors.lastname: Shen
authors.forename: Xiaopeng
authors.initials: X
authors.lastname: Liu
authors.forename: Ke
authors.initials: K
authors.lastname: Mei
authors.forename: Jian
authors.initials: J
authors.lastname: Cen
authors.forename: Yaming
authors.initials: Y
authors.lastname: Wang
authors.forename: Congyong
authors.initials: C
authors.lastname: Li
authors.forename: Yuanyuan
authors.initials: Y
authors.lastname: Ma
mesh_terms: D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D003561:Cytarabine / Q000008:administration & dosage; D003907:Dexamethasone / Q000008:administration & dosage; D005260:Female; D006801:Humans; D015255:Idarubicin / Q000008:administration & dosage; D008223:Lymphoma / Q000473:pathology / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D064847:Multimodal Imaging; D009367:Neoplasm Staging; D011379:Prognosis; D000069283:Rituximab
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D003561:Cytarabine; D000069283:Rituximab; D003907:Dexamethasone; D008727:Methotrexate; D015255:Idarubicin
keywords: R-IDARAM; diffuse large B-cell lymphoma; primary central nervous system lymphoma; stereotactic brachytherapy