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Successful Use of High Dose Methotrexate in Treatment of Primary CNS Lymphoma Patients Without Access to Serum Methotrexate Levels Monitoring: Challenges and Outcome

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Indian Journal of Hematology and Blood Transfusion Aims and scope Submit manuscript

Abstract

Aims and Objectives

High dose methotrexate (HDMTx) based chemotherapy forms the backbone of therapy for patients with Primary Central Nervous system Lymphoma (PCNSL). However, delivering HDMTx in resource constrained settings, especially without therapeutic drug monitoring, is difficult. We share our experience of treatment of patients with PCNSL at our center over a 10-year period with local adaptations made to deliver HDMTx.

Materials and Methods

We retrospectively analysed the case records of patients diagnosed with a PCNSL over the course of 10 years from 2010 to 2020.

Results

Fifty-five patients received therapy for newly diagnosed PCNSL. Thirty-six patients received Modified De-Angelis protocol ± Rituximab with curative intent. Fourteen of these patients were unable to complete the protocol with the most common cause being development of methotrexate toxicity. Patients unable to complete the designated 5 cycles of HDMTx had a poorer PS and higher probability of having a high IELSG score at baseline. Nineteen patients were given non HDMTx based therapy either due to advanced age or poor performance status. Twenty-nine patients (52.7%) were able to achieve a complete response. The most common cause of mortality was relapse/progressive disease. The Median EFS and OS of the cohort was 29 months and 40 months respectively.

Conclusion

All attempts should be made to have therapeutic drug level monitoring for administration of HDMTX based therapy for the patients with PCNSL, more so in patients who have poor performance status and a high IELSG score. If it is imperative to give HDMTx without access to TDM facility then a possible risk of higher toxicity should be explained to all patients, beforehand

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Acknowledgments

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Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

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Authors and Affiliations

  1. Clinical Hematology and BMT Division, Department of Internal Medicine, Nehru Hospital, Postgraduate Institute of Medical Education and Research, F block, 4th Floor, Chandigarh, 160012, India

    Charanpreet Singh, Arihant Jain, Deepesh Lad, Alka Khadwal, Subhash Varma, Pankaj Malhotra & Gaurav Prakash

  2. Department of Neurology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Aastha Takkar & Vivek Lal

  3. Department of Ophthalmology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Aniruddha Agarwal & Vishali Gupta

  4. Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Manish Rohilla

  5. Department of Nuclear Medicine, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    Rajender Basher

  6. Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

    B. D. Radotra, Amanjit Bal & Ashim Das

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  1. Charanpreet Singh
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  2. Arihant Jain
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  3. Aastha Takkar
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  8. Rajender Basher
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  9. B. D. Radotra
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  10. Amanjit Bal
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  11. Ashim Das
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  12. Vishali Gupta
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  13. Vivek Lal
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  14. Subhash Varma
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  15. Pankaj Malhotra
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  16. Gaurav Prakash
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Correspondence to Gaurav Prakash.

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Singh, C., Jain, A., Takkar, A. et al. Successful Use of High Dose Methotrexate in Treatment of Primary CNS Lymphoma Patients Without Access to Serum Methotrexate Levels Monitoring: Challenges and Outcome. Indian J Hematol Blood Transfus 38, 68–77 (2022). https://doi.org/10.1007/s12288-021-01438-5

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  • DOI: https://doi.org/10.1007/s12288-021-01438-5

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