Intravenous methotrexate as initial treatment for primary central nervous system lymphoma: Response to therapy and quality of life of patients

In anticipation of a consortium study of methotrexate (MTX) therapy provide d to patients with primary central nervous system lymphoma (PCNSL) we have provided intravenous MTX without irradiation therapy to 31 non-immunosuppre ssed individuals. Twenty (65%) achieved complete response and 11 (35%) part ial response to therapy. For the 31 patients the median survival was 30.43 months with an actuarial median follow up time of 30.69 months. The 2+ year survival was 63% for all patients and 90% for complete responders. Of 375 drug cycles, grade 3 leukopenia was identified in 3 cycles, mucositis in 6 cycles and delayed drug clearance in 47 cycles. Recurrences included brain (9/20) and/or spinal fluid (2/20). The median Karnofsky scale improved from 40 (10-80) prior to therapy to 90 after treatment. Eleven patients, in com plete response for a median of 22+ months after diagnosis were evaluated us ing 4 instruments that assess Quality of Life Functional Assessment of Canc er Therapy - Brain (FACT-BR) modified, Symptom Questionnaire, Social Adjust ment Scale-Self-Report and Problem Solving Inventory. Their psychosocial ad justment, well-being and stress coping abilities were comparable to the nor mative groups. Further there was no evidence of any MTX-induced, Magnetic R esonance Imaging (MRI)-detected encephalopathy in these individuals and the re was preservation of clinical cognition and memory. We conclude that ther apy with MTX, without radiation can be used in PCNSL patients without limit ations of age or pretreatment Karnofsky scores. Further rates of response a nd median survival approach those of therapies using multiple drugs and rad iation, but with a less likely risk of dementia.