Two cases of primary CNS lymphoma treated with rituximab and temozolomide

Abstract

저자들은 두통, 기억력 감퇴, 시야결손의 증상을 주소로 내원한 환자에서 두경부 MRI를 시행하여 원발성 중추신경계 림프종을 의심하였고, 뇌정위적 생검을 시행하여 확진한 후 rituximab과 temozolomide로 병합치료 후 특이 부작용 없이 완전관해에 도달하였기에 문헌고찰과 함께 보고하는 바이다.

Primary CNS lymphoma (PCNSL) is rare, occurring in 2～3% of all non-Hodgkin’s lymphoma. However, in recent years the incidence has increased. To date, the main treatment modalities are radiation therapy, steroids, methotrexate, or combination therapies. The response and overall prognosis remain poor. Use of CHOP in PCNSL has been disappointing in overall response, presumably due to poor penetration through the blood-brain barrier (BBB). We experienced excellent results using a combination of rituximab and the BBB-penetrating alkylating agent temozolomide. Two cases were diagnosed with PCNSL (diffuse large B cell lymphoma) with strong CD 20 positivity. They were placed on a 3-week cycle of rituximab 375 mg/m2 and 5 days of temozolomide 150 mg/m2. After six cycles of chemotherapy, repeat MRIs showed complete remission. Overall, tolerance to chemotherapy was excellent, with no significant marrow suppression. The combination of rituximab and temozolomide may be an effective regimen for the treatment of primary CNS lymphoma.