title: High-dose cytarabine salvage therapy for recurrent primary CNS lymphoma.
abstract: Treatment of recurrent primary CNS lymphoma (PCNSL) though not standardized most often utilizes whole brain radiotherapy, re-challenge with high-dose methotrexate, or administration of an alkylating chemotherapy. High-dose cytarabine (HD-araC) has been advocated as an active agent in PCNSL but limited information exists regarding single agent activity in the recurrent setting. A retrospective review of 14 patients (10 males, 4 females: median age 60 years) with recurrent PCNSL treated at second recurrence with single agent HD-araC. HD-araC was administered at 3gm/m(2) over a 3-h infusion every 12 h for a total of 4 doses (defined as a cycle of therapy). GM-CSF was administered at conclusion of HD-araC. Patients were clinically and radiographically evaluated every 4-weeks. Common toxicity criteria Grade 3 or 4 toxicity included thrombocytopenia (11 patients; 79%), anemia (10; 71%), fatigue (8; 57%), mucositis (8; 57%), neutropenia (8; 57%) and neutropenic fever (5; 36%). No patient discontinued therapy due to toxicity nor were there any treatment-related deaths. Best response to HD-araC was stable disease in 6 patients (43%), partial response in 5 (36%) and progressive disease in 3 (21%). Median progression free survival 3 months (range 2-5 months; 95% CI 2-4 months) and progression free survival was 0% at 6-months. Median survival after onset of HD-araC was 12 months (range 3-18+ months; 95% CI 3-15 months). Single agent HD-araC has limited activity in recurrent PCNSL and is associated with significant toxicity in this small retrospective study.
authors.affiliation: Department of Neurology and Neurological Surgery, Fred Hutchinson Cancer Research Institute, Seattle Cancer Care Alliance, University of Washington, 825 Eastlake Avenue East, POB 19023, Mailstop: G-4940, Seattle, WA, 98109-1023, USA. chambemc@u.washington.edu.
authors.forename: Marc C
authors.initials: MC
authors.lastname: Chamberlain
mesh_terms: D000368:Aged; D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy* / Q000473:pathology; D003561:Cytarabine / Q000627:therapeutic use*; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D016879:Salvage Therapy; D015996:Survival Rate
chemical_list: D000964:Antimetabolites, Antineoplastic; D003561:Cytarabine
keywords: Primary CNS lymphoma; Refractory to high dose methotrexate; Single agent high dose araC