Article ; Online: Long-term outcomes of combined intravitreal methotrexate and systemic high-dose methotrexate therapy in vitreoretinal lymphoma.
2023 Volume 12, Issue 7, Page(s) 8102–8111
Abstract: Objective: The optimal treatment for vitreoretinal lymphoma (VRL) remains a challenge, as central nervous system (CNS) relapse occurs frequently, leading to the worst impact on survival. We previously proposed combined intravitreal methotrexate and ... ...
| Abstract | Objective: The optimal treatment for vitreoretinal lymphoma (VRL) remains a challenge, as central nervous system (CNS) relapse occurs frequently, leading to the worst impact on survival. We previously proposed combined intravitreal methotrexate and systemic high-dose methotrexate therapy for this disease. This study aimed to report the long-term outcomes of patients with VRL using this combination treatment. Methods: We conducted a retrospective cohort study on patients with VRL at a tertiary referral center between 2003 and 2018. Results: Thirty-two patients were included, of whom 23 had primary VRL (PVRL) and nine had concurrent intraocular and CNS diseases. The treatment was well tolerated. Twenty-six (81.3%) patients achieved complete response (CR). After a median follow-up time of 103.5 months, the 5-year survival rate was 73.3%, whereas the 5-year progression-free survival (PFS) rate was 29.9%. Twenty-four (75%) patients relapsed, including 12 with isolated intraocular relapses at first relapse and a total of 17 with CNS/systemic relapses. The development of CNS/systemic relapse negatively affected survival, but intraocular relapse did not. The median CNS/systemic PFS was 69.5 months, but the risk of CNS/systemic relapse increased steadily with a cumulative incidence rate at 2, 5, and 10 years being 22.6%, 44.2%, and 65%, respectively. Multivariate analysis identified concurrent CNS disease at diagnosis as the only poor-risk factor for CNS/systemic relapse. Conclusions: This study confirms good efficacy and acceptable toxicities of the combination approach. However, incorporation of further intensive consolidation strategies into the treatment protocol to effectively prevent subsequent CNS/systemic relapse deserves to be considered. |
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| MeSH term(s) | Humans ; Methotrexate ; Retinal Neoplasms/drug therapy ; Retrospective Studies ; Neoplasm Recurrence, Local/drug therapy ; Neoplasm Recurrence, Local/pathology ; Vitreous Body/pathology ; Lymphoma, Non-Hodgkin/drug therapy ; Eye Neoplasms ; Central Nervous System Neoplasms ; Antineoplastic Combined Chemotherapy Protocols/adverse effects ; Treatment Outcome |
| Chemical Substances | Methotrexate (YL5FZ2Y5U1) |
| Language | English |
| Publishing date | 2023-01-05 |
| Publishing country | United States |
| Document type | Journal Article |
| ZDB-ID | 2659751-2 |
| ISSN | 2045-7634 ; 2045-7634 |
| ISSN (online) | 2045-7634 |
| ISSN | 2045-7634 |
| DOI | 10.1002/cam4.5609 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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