Intensive chemoimmunotherapy and bilateral globe irradiation as initial therapy for primary intraocular lymphoma.
BACKGROUND
Primary intraocular lymphoma is a rare variant of primary CNS lymphoma for which the optimum treatment strategy remains unknown.


METHODS
We performed a retrospective single-center study including patients who underwent uniform management from October 2007 in which patients were offered sequential rituximab, methotrexate, procarbazine, and vincristine (R-MPV) followed by binocular radiotherapy and consolidative high-dose cytarabine.


RESULTS
Eleven patients with median age 66 years (range, 48-72) were included. All patients received binocular radiotherapy to a median dose of 36 Gy (range, 30.6-39.6) in 20 fractions. Grade 3+ anemia, thrombocytopenia, and neutropenia occurred in 1 (9%), 2 (18%), and 3 (27%) patients, respectively; raised creatinine and peripheral sensory neuropathy occurred in 4 (36%) and 3 (27%) patients, respectively. Grade 3+ ocular toxicities included cataract formation and keratitis in 6 (54%) and 3 (27%) patients, respectively. Ten patients (91%) achieved complete response and 1 (9%) partial response. After median follow-up of 4.2 years (range, 1.8-7.6), the median progression-free survival was 3.8 years and the estimated 4-year overall survival was 75.8% (95% CI: 30.5%-93.7%). The initial site of disease progression was the CNS in 4 of 7 patients (57%) and within the eye in 3 of 7 (43%). Five patients achieved responses to salvage therapies.


CONCLUSIONS
Combined modality treatment with R-MPV, binocular radiation, and high-dose cytarabine is effective with moderate toxicity. Both local and CNS relapses occur; however, the achievement of second and subsequent remissions is possible.
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.).
Chan Yoon
CY
Cheah
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.).
Sarah
S
Milgrom
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.).
Dai
D
Chihara
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.).
Dan S
DS
Gombos
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.).
Chelsea C
CC
Pinnix
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.).
Bouthaina S
BS
Dabaja
Department of Lymphoma/Myeloma, The University of Texas MD Anderson Cancer Center, Houston, Texas (C.Y.C., D.C., N.H.F.); Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (S.M., C.C.P., B.S.D.); Department of Ophthalmology, The University of Texas MD Anderson Cancer Center, Houston, Texas (D.S.G.).
Nathan H
NH
Fowler
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D001932:Brain Neoplasms / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy; D016371:Cranial Irradiation; D003561:Cytarabine / Q000008:administration & dosage; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007167:Immunotherapy; D064090:Intraocular Lymphoma / Q000473:pathology / Q000628:therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011344:Procarbazine / Q000008:administration & dosage; D011379:Prognosis; D012074:Remission Induction; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
D003561:Cytarabine; D011344:Procarbazine; D014750:Vincristine; D008727:Methotrexate
methotrexate; primary central nervous system lymphoma; primary intraocular lymphoma; radiotherapy; treatment