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Clinical outcomes of primary intraocular lymphoma patients treated with front-line systemic high-dose methotrexate and intravitreal methotrexate injection

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Abstract

A standard treatment for patients with primary intraocular lymphoma (PIOL) remains unclear. This study retrospectively analyzed the clinical features and outcomes of 19 patients with PIOL who were treated with a first-line therapy comprising combined intravenous high-dose methotrexate and intravitreal methotrexate between January 2003 and December 2013. Thirteen (68.4 %) patients were female, and the median age at diagnosis was 57 (39–77 years). Diagnoses were based on the identification of abnormal lymphoid cells in vitreous fluid. Ten (52.6 %) patients had bilateral eye involvement, and six had concurrent central nervous system (CNS) involvement. All 19 patients achieved complete remission (CR) as confirmed by cytological examination of vitreous and cerebrospinal fluid and brain imaging if CNS was involved. Patients with concurrent brain involvement required a longer time to achieve CR. However, the duration of complete remission did not differ between patients with and without CNS involvement. The 5-year overall survival rate was 55.8 % for the total cohort and was higher (68.8 %) in patients with isolated PIOL than in those with concurrent CNS involvement. In all patients, methotrexate treatment was well tolerated, with manageable side effects. We conclude that combined intravitreal methotrexate and systemic high-dose methotrexate treatment is effective in patients with PIOL.

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Acknowledgments

This work was partially sponsored by grants NSC 103-2628-B-002-008-MY3 from the National Science Council (Taiwan) and MOHW103-TD-B-111-04 and MOST 103-2923-B-002-001 from the Ministry of Health and Welfare (Taiwan).

Authors’ contributions

Contribution: W.L.M. was responsible for literature collection, data management and interpretation, statistical analysis, and manuscript writing. Y.K.C. and Y.J.H. were responsible for data management and interpretation. H.A.H. was responsible for study design, data management, statistical analysis, and manuscript writing. W.T., P.T.Y., C.M.Y., and J.L.T. contributed to patient care and clinical data. H.F.T. and C.P.L. treated patients; planned, designed, and coordinated the study throughout the study period; and wrote the manuscript.

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Authors and Affiliations

  1. Division of Hematology, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Wei-Li Ma, Hsin-An Hou, Yin-Kai Chen, Jih-Luh Tang, Woei Tsay & Hwei-Fang Tien

  2. Department of Oncology, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan

    Wei-Li Ma

  3. Department of Ophthalmology, National Taiwan University Hospital, Taipei, Taiwan

    Ya-Jui Hsu, Po-Ting Yeh, Chung-May Yang & Chang-Ping Lin

  4. Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan

    Hwei-Fang Tien

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  1. Wei-Li Ma
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  2. Hsin-An Hou
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Correspondence to Chang-Ping Lin or Hwei-Fang Tien.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Ma, WL., Hou, HA., Hsu, YJ. et al. Clinical outcomes of primary intraocular lymphoma patients treated with front-line systemic high-dose methotrexate and intravitreal methotrexate injection. Ann Hematol 95, 593–601 (2016). https://doi.org/10.1007/s00277-015-2582-x

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