title: High-dose methotrexate monotherapy followed by radiation for CD30-positive, anaplastic lymphoma kinase-1-positive anaplastic large-cell lymphoma in the brain of a child.
abstract: The authors report the case of an 11-year-old immunocompetent boy with primary CNS CD30-positive anaplastic large-cell lymphoma (ALCL) that was also positive for anaplastic lymphoma kinase-1. His initial clinical manifestation was acute meningitis of unknown etiology. Findings on CT scanning were normal. Although he received empirical treatment against infection, his systemic and neurological status deteriorated. Subsequent MRI revealed newly emerged enhanced lesions and concomitant edema in the left parietal lobe. Diagnosis was confirmed following a brain biopsy and immunohistochemical staining. Three courses of systemic high-dose methotrexate (HD-MTX) treatment with 2-week intervals was started, followed by whole-brain radiation. His clinical course improved, and he has remained disease-free for more than 8 years without any additional treatment. Because ALCL originating in the brain is extremely rare and difficult to diagnose, no standard treatment has been established. This report suggests that systemic HD-MTX monotherapy can be an effective and worthwhile tailored therapeutic option for pediatric primary CNS ALCL.
authors.affiliation: Departments of Neurosurgery and.
authors.forename: Kazuhide
authors.initials: K
authors.lastname: Furuya
authors.forename: Shigehiko
authors.initials: S
authors.lastname: Takanashi
authors.forename: Akiko
authors.initials: A
authors.lastname: Ogawa
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Tadayoshi
authors.initials: T
authors.lastname: Nakagomi
mesh_terms: D000077548:Anaplastic Lymphoma Kinase; D000964:Antimetabolites, Antineoplastic / Q000008:administration & dosage*; D001706:Biopsy; D001932:Brain Neoplasms / Q000737:chemistry / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D017024:Chemotherapy, Adjuvant; D002648:Child; D016371:Cranial Irradiation; D019299:Decompression, Surgical; D018572:Disease-Free Survival; D004334:Drug Administration Schedule; D006801:Humans; D007150:Immunohistochemistry; D019586:Intracranial Hypertension / Q000209:etiology / Q000601:surgery; D017730:Ki-1 Antigen / Q000032:analysis; D017728:Lymphoma, Large-Cell, Anaplastic / Q000737:chemistry / Q000150:complications / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage*; D018714:Radiotherapy, Adjuvant; D020794:Receptor Protein-Tyrosine Kinases / Q000032:analysis; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D017730:Ki-1 Antigen; C000626173:ALK protein, human; D000077548:Anaplastic Lymphoma Kinase; D020794:Receptor Protein-Tyrosine Kinases; D008727:Methotrexate
keywords: ALCL = anaplastic large-cell lymphoma; ALK-1 = anaplastic lymphoma kinase-1; CD30; HD-MTX = high-dose methotrexate; PCNSL = primary CNS lymphoma; anaplastic large-cell lymphoma; anaplastic lymphoma kinase-1; central nervous system; methotrexate; oncology; treatment