Combined intravitreal methotrexate and immunochemotherapy followed by reduced-dose whole-brain radiotherapy for newly diagnosed primary B-cell intraocular lymphoma

Abstract

Purpose : Primary intraocular lymphoma (IOL) has propensity for cerebrospinal relapse within two years of initial diagnosis, which aggravates clinical outcome. The purpose of our study was to determine whether early initiation of cerebrospinal prophylaxis with rituximab, methotrexate (MTX), procarbazine, and vincristine (R-MPV), reduced-dose whole-brain radiotherapy (rdWBRT), and high-dose cytarabine (HD-AraC) reduced the cerebrospinal relapse rate and improved 2-year progression-free survival (PFS) and overall survival (OS) in patients with primary IOL.

Methods : Patients and methods:
Primary B-cell IOL patients with or without newly diagnosed cerebrospinal involvement were treated 10 times with intravitreal MTX and five to seven cycles of R-MPV. Patients that achieved a complete response received rdWBRT (23.4 Gy). Two cycles of HD-AraC were given after rdWBRT. All patients received longitudinal magnetic resonance imaging (MRI) of the brain and cognitive assessment for evaluation of treatment-induced leukoencephalopathy.

Results : Fifteen patients with a median age of 63 years and a median Karnofsky performance score of 90 received the complete protocol treatment. Cerebrospinal relapse occurred in one patient and intraocular relapse occurred in two patients. The 2-year PFS was 78.8% and the 4-year OS was 92.3% with a median follow-up of 52.2 months. Of the 10 patients without cerebrospinal involvement at initial diagnosis, no cerebrospinal relapse occurred, and the 4-year OS was 100% with a median follow-up of 55.3 months. All patients had preserved cognitive function during follow-up. Although white matter abnormalities on MRI increased gradually, no patients developed modified Fazekas of grades 4 to 5.

Conclusions : The 20% relapse rate achieved in our study is the lowest in any reports regarding primary IOL to date (53.8–78.9%). The early cerebrospinal prophylaxis with chemotherapy and radiotherapy in primary B-cell IOL patients reduced the cerebrospinal relapse rate and improved 2-year PFS and OS without compromising neurocognitive function.

This is an abstract that was submitted for the 2016 ARVO Annual Meeting, held in Seattle, Wash., May 1-5, 2016.