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Li-Anne S Lim, Lauren A Dalvin, David Ancona-Lezama, Michael Chang, Arman Mashayekhi, Carol L. Shields; Intravitreal melphalan for vitreoretinal lymphoma. Invest. Ophthalmol. Vis. Sci. 2019;60(9):2778.
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© ARVO (1962-2015); The Authors (2016-present)
To assess the efficacy of intravitreal melphalan for treatment of vitreoretinal lymphoma (VRL).
Retrospective review of medical records of VRL patients treated with monthly intravitreal melphalan from September 2015 to November 2018.
There were 12 eyes of 6 patients (3 male and 3 female) diagnosed with VRL at mean age of 70 years. At presentation, no patients were immunosuppressed, 1 patient had central nervous system (CNS) lymphoma, and 2 had systemic lymphoma in remission without treatment. Six eyes had had previous vitrectomy and 2 eyes had been treated with topical and oral steroids before referral. Eyes were treated with melphalan 10µg/0.05ml for a mean of 5 injections (median 6, range 1-14) as initial treatment. Mean number of injections to VRL regression was 3 (median 3, range 1-8). At mean follow-up of 12 months there was complete regression in 6 eyes (50%), partial regression in 3 eyes (25%), disease progression requiring change in treatment to intravitreal methotrexate with good tumor control in 2 eyes (17%), and 1 eye (8%) had recurrent disease after 2 months of complete regression without treatment requiring additional intravitreal melphalan injections. There was no difference in likelihood of achieving complete regression in eyes with sub-retinal pigment epithelial lymphoma (n=8, 67%) compared to eyes with vitreous lymphoma alone (n=4, 33%), (4 vs 2, p=0.3). At final follow-up, 1 eye (8%) was not receiving any form of treatment and 3 eyes (25%) were receiving ongoing monthly intravitreal melphalan without any other systemic treatment. Two patients (4 eyes, 33%) developed CNS lymphoma during the course of follow- up and were receiving ongoing monthly intravitreal melphalan and systemic methotrexate or combined methotrexate/rituximab for CNS lymphoma respectively. One patient (2 eyes, 17%) was not receiving any intravitreal treatment but systemic obinutuzumab (n=2, 17%) for treatment of skin lymphoma. There were no ocular complications from intraocular injection and a 2-line loss of Snellen visual acuity only occurred in 1 eye (8%) secondary to epiretinal membrane. All patients were alive at the last visit.
Monthly intravitreal injections of melphalan at a dose of 10µg/0.05 ml resulted in complete or partial control of VRL in 9 (75%) of the 12 treated eyes. Further studies are needed to determine the optimal dosage and interval between injections.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.
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