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White matter changes in primary central nervous system lymphoma patients treated with high-dose methotrexate with or without rituximab

  • Clinical Study
  • Published:
Journal of Neuro-Oncology Aims and scope Submit manuscript

A Correction to this article was published on 22 November 2019

This article has been updated

Abstract

Purpose

White matter changes (WMCs) can develop following systemic chemotherapy in patients with primary central nervous system lymphomas (PCNSLs), but the frequency and extent of these changes is not well characterized. This single center retrospective semi-quantitative study was performed to determine the rate, timing and grade of WMC on MRI in adult patients with newly-diagnosed radiotherapy-naïve PCNSL undergoing treatment with high-dose methotrexate (HD-MTX) with or without the addition of rituximab (-R).

Methods

Serial MRI scans of consecutive adult PCNSL patients treated with HD-MTX ± R were assessed for WMC comparing the pre-treatment to post-treatment scans utilizing a 0-to-8-point severity scoring system.

Results

Forty-seven PCNSL patients treated with either HD-MTX-R (n = 34; median age 66, 50% male) or HD-MTX (n = 13; median age 53, 54% male) were included in the analysis. WMC were detected in 62% (95% CI 46–76%) overall, in 68% of the HD-MTX-R, and in 46% of the HD-MTX group. Among patients with WMC (n = 29), WMC were first detected at an average of 2.8 months from beginning of therapy in the HD-MTX-R versus at 10.7 months in the HD-MTX group. Average WMC non-zero scores when first detected following the start of treatment were 2.5 (± 1.1) in HD-MTX-R and 1.5 (± 0.6) in HD-MTX.

Conclusions

Development of WMC in PCNSL patients treated with MTX and MTX-R is common. WMC changes appear to be more frequent, occur earlier and are more extensive in patients treated with HD-MTX-R compared to HD-MTX. Prospective studies are required to determine whether WMC correlate with survival or neurocognitive outcomes.

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Change history

  • 22 November 2019

    The following discrepancies and errors were found in the original publication:

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Acknowledgements

This study was supported by the Sidney Kimmel Comprehensive Cancer Center Core Grant P30CA006973 and the generosity of the Fernandes-Martins family and the Greening family.

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Author notes

  1. Fayez Estephan, Xiaobu Ye and Omar Dzaye contributed equally.

Authors and Affiliations

  1. The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Baltimore, MD, USA

    Fayez Estephan, Xiaobu Ye, Omar Dzaye, Nina Wagner-Johnston, Lode Swinnen, Douglas E. Gladstone, Rich Ambinder, David Olayinka Kamson, Stuart A. Grossman & Matthias Holdhoff

  2. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Xiaobu Ye

  3. Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Omar Dzaye, Sebastian Lambrecht & Doris D. M. Lin

  4. Department of Radiology and Neuroradiology, Charité, Berlin, Germany

    Omar Dzaye

  5. The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, Viragh Building, 9th floor, 201 North Broadway, Mailbox 3, Baltimore, MD, 21287, USA

    Matthias Holdhoff

  6. Division of Neuroradiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 North Wolfe Street, Baltimore, MD, 21287, USA

    Doris D. M. Lin

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  1. Fayez Estephan
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Correspondence to Doris D. M. Lin or Matthias Holdhoff.

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Estephan, F., Ye, X., Dzaye, O. et al. White matter changes in primary central nervous system lymphoma patients treated with high-dose methotrexate with or without rituximab. J Neurooncol 145, 461–466 (2019). https://doi.org/10.1007/s11060-019-03279-9

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