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Methotrexate-based remission induction regimens for primary central nervous system lymphoma

Methotrexate-based remission induction regimens for primary central nervous system lymphoma
Regimen Drug Dose, route Schedule
(28-day cycle except as otherwise noted)
Methotrexate, temozolomide, rituximab (MTR)[1] MTX 8 g/m2 IV* Days 1, 15
TMZ 150 mg/m2 per day, PO Days 7 through 11
RTX 375 mg/m2 IV Weekly starting on day 3 of cycle 1, for 6 total doses
Methotrexate, procarbazine, vincristine, rituximab (R-MPV)[2] MTX 3.5 g/m2 IV*Δ Days 2, 16
PRO 100 mg/m2 per day, PO Days 7 through 13
VCR 1.4 mg/m2 (max 2.8 mg) IV Days 2, 16
RTX 500 mg/m2 IV Days 1, 15
Methotrexate, cytarabine, thiotepa, rituximab (MATRix)[3]     21-day cycle:
MTX 3.5 g/m2 IV*
  • Day 1
Cytarabine 2 g/m2 every 12 hours IV
  • Days 2, 3
Thiotepa 30 mg/m2 IV
  • Day 4
RTX 375 mg/m2 IV
  • Days (–5), 0
Methotrexate, carmustine, etoposide, prednisone, rituximab (R-MBVP)[4] MTX 3 g/m2 IV* Days 1, 15
Carmustine 100 mg/m2 IV Day 3
Etoposide 100 mg/m2 IV Day 2
Prednisone 60 mg/kg per day, PO Days 1 through 5
RTX 375 mg/m2 IV Day 1

MTX: methotrexate; TMZ: temozolomide; RTX: rituximab; IV: intravenous; PO: by mouth; PRO: procarbazine; VCR: vincristine.

* With leucovorin rescue.

¶ Patients with T cell primary central nervous system lymphoma did not receive RTX.

Δ Intraventricular MTX 12 mg via Ommaya reservoir administered between days 5 and 12, and 19 and 26 of each cycle for patients with positive cerebrospinal fluid (CSF) cytology.
References:
  1. Rubenstein JL, Hsi ED, Johnson JL, et al. Intensive chemotherapy and immunotherapy in patients with newly diagnosed primary CNS lymphoma: CALGB 50202 (Alliance 50202). J Clin Oncol 2013; 31:3061.
  2. Shah GD, Yahalom J, Correa DD, et al. Combined immunochemotherapy with reduced whole-brain radiotherapy for newly diagnosed primary CNS lymphoma. J Clin Oncol 2007; 25:4730.
  3. Ferreri AJ, Cwynarski K, Pulczynski E, et al. Chemoimmunotherapy with methotrexate, cytarabine, thiotepa, and rituximab (MATRix regimen) in patients with primary CNS lymphoma: Results of the first randomisation of the International Extranodal Lymphoma Study Group-32 (IELSG32) phase 2 trial. Lancet Haematol 2016; 3:e217.
  4. Houillier C, Taillandier L, Dureau S, et al. Radiotherapy or autologous stem-cell transplantation for primary CNS lymphoma in patients 60 years of age and younger: Results of the intergroup ANOCEF-GOELAMS randomized phase II PRECIS study. J Clin Oncol 2019; 37:823.
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