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Case Reports
. 2015;4(6):393-8.
doi: 10.2217/cns.15.34. Epub 2015 Oct 28.

Late relapses in primary CNS lymphoma after complete remissions with high-dose methotrexate monotherapy

Prakash Ambady  1   2 , Matthias Holdhoff  1   2 , David Bonekamp  3 , Fay Wong  2 , Stuart A Grossman  1   2
Affiliations
Case Reports

Late relapses in primary CNS lymphoma after complete remissions with high-dose methotrexate monotherapy

Prakash Ambady et al. CNS Oncol. 2015.

Abstract

Treatment of patients with newly diagnosed primary CNS lymphomas using high dose methotrexate regimens is reported to yield about 30% long term survivors with minimal neurotoxicity. As in other systemic large cell lymphomas, it is generally assumed that most relapses occur within 5 years of diagnosis. A retrospective review of the Johns Hopkins experience in 52 patients treated between 1995 and 2008 yielded 19 patients (37%) who achieved a complete response and were followed for over 5 years. Four of these patients remained progression-free for over 10 years. However, two of these long-term survivors have now relapsed over 10 years after their initial diagnosis. An analysis of progression and overall survival does not reveal a plateau suggesting that even patients who have not recurred for over 10 years remain at high risk for relapse after treatment with single agent high dose methotrexate.

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Conflict of interest statement

Financial & competing interests disclosure NCI grant support for cancer center (NCI: 5P30CA006973, PI: Nelson) was utilized for this manuscript. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed. No writing assistance was utilized in the production of this manuscript.

Figures

<b>Figure 1.</b>
Figure 1.. Study schema.
This figure describes the algorithm used to attain the study population. Patients who did not attain CR, received radiation or alternate treatment regimens or with inadequate follow-up, were excluded.
<b>Figure 2.</b>
Figure 2.. Kaplan–Meier curve showing progression-free survival and overall survival in 19 patients who attained CR with HD-MTX monotherapy.
See this image and copyright information in PMC

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