Yonsei Med J.  2009 Apr;50(2):280-283.

A Successful Treatment of Relapsed Primary CNS Lymphoma Patient with Intraventricular Rituximab Followed by High-Dose Chemotherapy with Autologous Stem Cell Rescue

• Hong SJ
• Kim JS
• Chang JH
• Kim KM
• Kim SJ
• Lee HW
• Cheong JW
• Lee ST
• Min YH

Abstract

The prognosis for patients with primary central nervous system (CNS) lymphoma (PCNSL) who relapse after the initial response is usually poor. A standard treatment for relapsed PCNSL has not yet been identified because of the heterogeneity of the therapies employed and the lack of large, prospective clinical trials. We describe a 46-year-old relapsed PCNSL patient who was successfully treated with intraventricular applications of rituximab to minimize neurotoxicity, 2 cycles of salvage chemotherapy with etoposide, ifosfamide, and cytarabine (VIA) regimen and high-dose chemotherapy with autologous stem cell rescue. The high-dose chemotherapy consisted of bischloroethylnitrosourea, etoposide, cytarabine, and melphalan (BEAM) regimen. Partial remission was detected after intraventricular rituximab therapy and the patient has been in complete remission without evidence of neurotoxicity for 28 months after high-dose chemotherapy with autologous stem cell rescue. This case indicates a new appropriate treatment guideline in relapsed PCNSL patient after initial intensive chemo-radiotherapy.

Keyword

Primary central nervous system lymphoma; salvage therapy; rituximab; high-dose chemotherapy with autologous stem cell rescue

MeSH Terms

Antibodies, Monoclonal/*therapeutic use
Central Nervous System Neoplasms/*drug therapy/*therapy
Cytarabine/therapeutic use
Etoposide/therapeutic use
Female
Humans
Ifosfamide/therapeutic use
Lymphoma, Non-Hodgkin/*drug therapy/*therapy
Middle Aged
Stem Cell Transplantation/*methods

Figure

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  Fig. 1 Gadolinium-enhanced, T1-weighted, MRI shows an enhancing lesion involving the right thalamus and splenium of the corpus callosum at relapse.

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  Fig. 2 About 50% reduction of the lesion size in the right thalamus after treatment of intraventricular rituximab.

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  Fig. 3 Full regression of lymphoma infiltration after 2 cycles of VIA chemotherapy and high-dose chemotherapy with autologous stem-cell rescue.

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