A SINGLE-CENTER STUDY OF 11 PATIENTS WITH INTRAOCULAR LYMPHOMA TREATED WITH CONVENTIONAL CHEMOTHERAPY FOLLOWED BY HIGH-DOSE CHEMOTHERAPY AND AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN 5 CASES

Intraocular lymphoma (IOL) is a rare form of non Hodgkin lymphoma (NHL ); it has a poor prognosis and is frequently associated with central n ervous system (CNS) infiltration. We report the results of a prospecti ve study of 11 patients with IOL who received conventional chemotherap y (CT), followed by salvage high-dose (HD) CT with autologous bone mar row transplantation (ABMT) in five cases. All 11 patients had abnormal funduscopic findings and six had CNS involvement at diagnosis. The di agnosis was based on vitrectomy in 10 cases and cerebral stereotaxic b iopsy in one. Pathologic studies showed large-cell NHL in all cases. T hese large-cell NHL were of the B-cell type in 8 cases and of the T-ce ll type in two. First-line therapy consisted of a combination of cispl atin 25 mg/m(2) as a 24-hour IV infusion on 4 consecutive days, VP-16 40 mg/m2 for 4 days, aracytine 2 g/m(2) IV on day 5, and methylprednis olone 500 mg IV daily for 5 days (ESHAP) in 5 cases; alternating cours es of ESHAP and HD methotrexate (MTX) in 4 cases; and HD MTX in 2 case s. Three patients underwent ocular and whole-brain radiation therapy. Five refractory patients subsequently received intensive CT with thiot epa 750 mg/m2, busulfan 10 mg/kg and cyclophosphamide 120 mg/kg, follo wed by ABMT. First-line treatment failed in 10 evaluable cases. One pa tient died of CNS progression at 12 months. All the patients who under went intensive CT and ABMT entered CR; two relapsed at 6 months and th ree are alive in CR 15, 15 and 14 months after ABMT. Six patients are alive with persistent disease at 8, 13, 14, 15, 18 and 24 months. It s eems in conclusion that, high-dose thiotepa, busulfan and cyclophospha mide followed by ABMT is effective in some cases of refractory IOL.