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Bertil Damato, Greg Bever, Jinwon Kim, Armin Afshar, James Rubenstein; Systemic therapy for vitreo-retinal lymphoma: a single-center experience. Invest. Ophthalmol. Vis. Sci. 2018;59(9):5580.
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To evaluate systemic therapy for vitreo-retinal lymphoma in patients treated at a single institution.
Patients were included if treated for vitreo-retinal lymphoma at UCSF between 2013 and 2017. Treatment was systemic, with ocular radiotherapy or intra-vitreal chemotherapy reserved only for resistant or recurrent ocular disease. Patients were excluded if mostly treated elsewhere.
The 15 patients (12 women, 3 men) had a median age of 55 years (range, 34-69) at the time of retinal and/or CNS lymphoma, whichever was diagnosed first. Nine patients had a history of CNS lymphoma when their retinal disease was diagnosed. Retinal disease was initially present in 20/30 eyes. Systemic treatment consisted of methotrexate (12 patients), temozolamide (12), lenalidomide (11), rituximab (9), etoposide (8) and a variety of other agents. Ocular treatment was subsequently required in 8/30 eyes, consisting of bilateral radiotherapy in 2 patients, unilateral radiotherapy in 2, unilateral therapeutic vitrectomy in 1, and unilateral intra-vitreal melphalan injection in 1. The median follow-up to the latest ocular exam was 34 months (range, 0.7 – 101). At the latest visit, the visual acuity was 20/15 to 20/32 in 18 eyes (60%), 20/40 to 20/80 in 7 (23%), 20/100 to 20/200 in 1 (3%), Count Fingers in 2 (7%) and HM to NLP in 2 (7%). Ocular disease regressed in 16 out of 20 eyes presenting with retinal lymphoma and developed in 6 out of 10 eyes that were initially free of lymphoma. Two patients died by the close of the study, 11 & 91 months after diagnosis of ocular or CNS lymphoma, whichever was earlier, resulting in an actuarial survival rate of 90.1% at 100 months.
In most patients with vitreo-retinal lymphoma, the ocular disease can be controlled with systemic therapy alone. Although previous reports do not show such therapy to prolong life, our results are more encouraging and suggest scope for studies evaluating protocols that include immunomodulatory agents, such as lenalidomide. Further studies are needed to test our hypothesis that vitreous infiltrates are more resistant to systemic therapy than subretinal infiltrates. This would indicate a need to categorize vitreo-retinal lymphoma according to the severity of lymphomatous infiltration in the vitreous and sub-RPE space.
This is an abstract that was submitted for the 2018 ARVO Annual Meeting, held in Honolulu, Hawaii, April 29 - May 3, 2018.
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