title: High-dose methotrexate with or without rituximab in newly diagnosed primary CNS lymphoma.
abstract: OBJECTIVE
  To evaluate the efficacy of rituximab (R) when added to high-dose methotrexate (HD-MTX) in patients with newly diagnosed immunocompetent primary CNS lymphomas (PCNSLs).
  
  
  METHODS
  Immunocompetent adults with newly diagnosed PCNSL treated at The Johns Hopkins Hospital between 1995 and 2012 were investigated. From 1995 to 2008, patients received HD-MTX monotherapy (8 g/m2 initially every 2 weeks and after complete response [CR] monthly to complete 12 months of therapy). From 2008 to 2012, patients received the same HD-MTX with rituximab (375 mg/m2) with each HD-MTX treatment. CR rates and median overall and progression-free survival were analyzed for each patient cohort in this single-institution, retrospective study.
  
  
  RESULTS
  A total of 81 patients were identified: 54 received HD-MTX (median age 66 years) while 27 received HD-MTX/R (median age 65 years). CR rates were 36% in the HD-MTX cohort and 73% in the HD-MTX/R cohort (p = 0.0145). Median progression-free survival was 4.5 months in the HD-MTX cohort and 26.7 months in the HD-MTX/R cohort (p = 0.003). Median overall survival was 16.3 months in the HD-MTX cohort and has not yet been reached in the HD-MTX/R cohort (p = 0.01).
  
  
  CONCLUSIONS
  The addition of rituximab to HD-MTX appears to improve CR rates as well as overall and progression-free survival in patients with newly diagnosed PCNSL. Comparisons of long-term survival in the 2 cohorts await further maturation of the data.
  
  
  METHODS
  This study provides Class III evidence that in immunocompetent patients with PCNSL, HD-MTX plus rituximab compared with HD-MTX alone improves CR and overall survival rates.
authors.affiliation: From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD. mholdho1@jhmi.edu.
authors.forename: Matthias
authors.initials: M
authors.lastname: Holdhoff
authors.affiliation: From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Prakash
authors.initials: P
authors.lastname: Ambady
authors.affiliation: From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Abdelaziz
authors.affiliation: From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Guneet
authors.initials: G
authors.lastname: Sarai
authors.affiliation: From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: David
authors.initials: D
authors.lastname: Bonekamp
authors.affiliation: From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Jaishri
authors.initials: J
authors.lastname: Blakeley
authors.affiliation: From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Stuart A
authors.initials: SA
authors.lastname: Grossman
authors.affiliation: From the Brain Cancer Program (M.H., P.A., A.A., G.S., J.B., S.A.G., X.Y.), The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins; and Departments of Oncology (M.H., S.A.G.), Radiology (D.B.), Neurology (J.B.), and Neurosurgery (X.Y.), The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Xiaobu
authors.initials: X
authors.lastname: Ye
mesh_terms: D000328:Adult; D000368:Aged; D058846:Antibodies, Monoclonal, Murine-Derived / Q000008:administration & dosage / Q000494:pharmacology*; D000970:Antineoplastic Agents / Q000008:administration & dosage / Q000494:pharmacology*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy*; D018572:Disease-Free Survival; D004359:Drug Therapy, Combination; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000494:pharmacology*; D008223:Lymphoma / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000494:pharmacology*; D008875:Middle Aged; D012189:Retrospective Studies; D000069283:Rituximab; D016896:Treatment Outcome
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D007166:Immunosuppressive Agents; D000069283:Rituximab; D008727:Methotrexate