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lüll High-dose methotrexate for elderly patients with primary CNS lymphoma Zhu JJ; Gerstner ER; Engler DA; Mrugala MM; Nugent W; Nierenberg K; Hochberg FH; Betensky RA; Batchelor TTNeuro Oncol 2009[Apr]; 11 (2): 211-5The introduction of methotrexate (MTX)-based chemotherapy has improved median survival for patients with primary CNS lymphoma (PCNSL). Older age is a negative prognostic marker in patients with PCNSL and may increase the likelihood of MTX toxicity. We studied the response and adverse effects of intravenous high-dose MTX in patients who were 70 or more years of age at the time of diagnosis. We identified 31 patients at our institution diagnosed with PCNSL at age > or =70 years (median, 74 years) who were treated with high-dose MTX (3.5-8 g/m(2)) as initial therapy from 1992 through 2006. The best response to MTX was determined by contrast-enhanced MRI. Toxicity was analyzed by chart review. These 31 patients received a total of 303 cycles of MTX (median, eight cycles per patient). Overall, 87.9% of the cycles required dose reduction because of impaired creatinine clearance. In 30 evaluable patients, the overall radiographic response rate was 96.7%, with 18 complete responses (60%) and 11 partial responses (36.7%). Progression-free survival and overall survival were 7.1 months and 37 months, respectively. Grade I-IV toxicities were observed in 27 of 31 patients and included gastrointestinal disturbances in 58% (3.2% grade III), hematological complications in 80.6% (6.5% grade III), and renal toxicity in 29% (0% grade III/IV). High-dose MTX is associated with a high proportion of radiographic responses and a low proportion of grade III/IV toxicity in patients 70 or more years of age. High-dose MTX should be considered as a feasible treatment option in elderly patients with PCNSL.|Aged[MESH]|Aged, 80 and over[MESH]|Antimetabolites, Antineoplastic/*therapeutic use[MESH]|Central Nervous System Neoplasms/*drug therapy/pathology[MESH]|Dose-Response Relationship, Drug[MESH]|Female[MESH]|Follow-Up Studies[MESH]|Humans[MESH]|Lymphoma/*drug therapy/pathology[MESH]|Male[MESH]|Methotrexate/*therapeutic use[MESH]|Prognosis[MESH]|Survival Rate[MESH]|Treatment Outcome[MESH] |