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M. Zierhut, C.M. E. Deuter, S. Biester, K.–U. Bartz–Schmidt, M. Rohrbach; Methotrexate in the Treatment of Intraocular Lymphoma . Invest. Ophthalmol. Vis. Sci. 2005;46(13):5407.
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© ARVO (1962-2015); The Authors (2016-present)
Purpose: Intraocular lymphoma, the ocular disorder with the lowest 5–year survival rate, has a growing incidence, but the treatment modalities of the last years were not able to change the prognosis for survival of appr. 20 months. For CNS associated lymphoma it has been shown that intravenously administered Methotrexate (MTX) improves significantly the 5–years survival rate. First results of our study in patients with intraocular lymphoma using MTX intravenously will be presented. Methods: In the last years we have treated 9 patients with intraocular lymphoma primarily with intravenous (i. v.) MTX (dosage 3 g/m2) using a prospective study protocol of the Neurological Society from Germany. Four of these 9 patients had received a complete treatment of 6 cycles MTX (group A). Five patients had to stop because of side effects like renal dysfunction starting with alternative chemotherapy and/or radiation (group B). Results: The age of the patients treated with MTX i. v. ranged from 46 until 76 years (mean 61.7). All patients who completed the MTX therapy (group A) are still alive (mean 35 months) without having any recurrences or additional therapy. All 5 patients who could not complete MTX treatment (group B), died between 2–29 months (mean 18.2). Two of these patients had developed lung emboli, which caused death in one of them. All others died due to recurrences. Conclusions: While in previous studies radiation and various forms of cytostatic therapy concepts including intravitreal MTX injection have not improved the 5–years survival rate, we have some evidence that intravenously applied MTX can be a good therapy if all 6 cycles are tolerated (group A). Unfortunately, creatinine increase seems to limit this treatment. Further control and larger patient numbers may show a possible extension of the 5 year survival rate. So, the full cycle course of high dose MTX i. v., but not a reduced number of cycles seems to lower mortality of introcular lyphoma.
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