High-dose methotrexate for elderly patients with primary CNS lymphoma

Jay Jiguang Zhu, Elizabeth R. Gerstner, David A. Engler, Maciej M. Mrugala, Whitney Nugent, Kristin Nierenberg, Fred H. Hochberg, Rebecca A. Betensky, Tracy T. Batchelor

Research output: Contribution to journalArticle

Abstract

The introduction of methotrexate (MTX)-based chemotherapy has improved median survival for patients with primary CNS lymphoma (PCNSL). Older age is a negative prognostic marker in patients with PCNSL and may increase the likelihood of MTX toxicity. We studied the response and adverse effects of intravenous high-dose MTX in patients who were 70 or more years of age at the time of diagnosis. We identified 31 patients at our institution diagnosed with PCNSL at age ≥70 years (median, 74 years) who were treated with high-dose MTX (3.5-8 g/m2) as initial therapy from 1992 through 2006. The best response to MTX was determined by contrastenhanced MRI. Toxicity was analyzed by chart review. These 31 patients received a total of 303 cycles of MTX (median, eight cycles per patient). Overall, 87.9% of the cycles required dose reduction because of impaired creatinine clearance. In 30 evaluable patients, the overall radiographic response rate was 96.7%, with 18 complete responses (60%) and 11 partial responses (36.7%). Progression-free survival and overall survival were 7.1 months and 37 months, respectively. Grade IIV toxicities were observed in 27 of 31 patients and included gastrointestinal disturbances in 58% (3.2% grade III), hematological complications in 80.6% (6.5% grade III), and renal toxicity in 29% (0% grade III/IV). High-dose MTX is associated with a high proportion of radiographic responses and a low proportion of grade III/IV toxicity in patients 70 or more years of age. High-dose MTX should be considered as a feasible treatment option in elderly patients with PCNSL.

Original languageEnglish (US)
Pages (from-to)211-215
Number of pages5
JournalNeuro-Oncology
Volume11
Issue number2
DOIs
StatePublished - Apr 2009

Keywords

  • Chemotherapy
  • Elderly
  • High-dose methotrexate
  • Primary CNS lymphoma

ASJC Scopus subject areas

  • Oncology
  • Clinical Neurology
  • Cancer Research

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  • Cite this

    Zhu, J. J., Gerstner, E. R., Engler, D. A., Mrugala, M. M., Nugent, W., Nierenberg, K., Hochberg, F. H., Betensky, R. A., & Batchelor, T. T. (2009). High-dose methotrexate for elderly patients with primary CNS lymphoma. Neuro-Oncology, 11(2), 211-215. https://doi.org/10.1215/15228517-2008-067