TY - JOUR
T1 - Area under the curve of methotrexate and creatinine clearance are outcome-determining factors in primary CNS lymphomas
AU - Ferreri, A. J M
AU - Guerra, E.
AU - Regazzi, M.
AU - Pasini, F.
AU - Ambrosetti, A.
AU - Pivnik, A.
AU - Gubkin, A.
AU - Calderoni, A.
AU - Spina, M.
AU - Brandes, A.
AU - Ferrarese, F.
AU - Rognone, A.
AU - Govi, S.
AU - Dell'Oro, S.
AU - Locatelli, M.
AU - Villa, E.
AU - Reni, M.
PY - 2004/1/26
Y1 - 2004/1/26
N2 - Although high-dose methotrexate (HD-MTX) is the most effective drug against primary CNS lymphomas (PCNSL), outcome-determining variables related to 'its administration schedule have not been defined. The impact on toxicity and outcome of the area under the curve (AUCMTX), dose intensity (DI MTX) and infusion rate (IRMTX) of MTX and plasmatic creatinine clearance (CLcrea) was investigated in a retrospective series of 45 PCNSL patients treated with three different HD-MTX-based combinations. Anticonvulsants were administered in 31 pts (69%). Age >60 years, anticonvulsant therapy, slow IRMTX (≤800 mg m -2h-1), and reduced DIMTX (≤ 1000 mg m -2wk-1) were significantly correlated with low AUC MTX values, Seven patients (16%) experienced severe toxicity, which was independently associated with slow CLcrea. A total of 18 (40%) patients achieved complete remission after chemotherapy, which was independently associated with slow CLcrea. In all, 22 patients were alive at a median follow-up of 31 months, with a 3-year OS of 40 ± 9%; slow CLcrea and AUCMTX > 1100 μmol h l-1 were independently associated with a better survival. Slow CLcrea and high AUCMTX are favourable outcome-determining factors in PCNSL, while slow CLcrea is significantly related to higher toxicity. AUCMTX significantly correlates with age, anticonvulsant therapy, IRMTX, and DIMTX. These findings, which seem to support the choice of an MTX dose ≥ 3 g m-2 in a 4-6-h infusion, every 3-4 weeks, deserve to be assessed prospectively in future trials. MTX dose adjustments in patients with fast CLcrea should be investigated.
AB - Although high-dose methotrexate (HD-MTX) is the most effective drug against primary CNS lymphomas (PCNSL), outcome-determining variables related to 'its administration schedule have not been defined. The impact on toxicity and outcome of the area under the curve (AUCMTX), dose intensity (DI MTX) and infusion rate (IRMTX) of MTX and plasmatic creatinine clearance (CLcrea) was investigated in a retrospective series of 45 PCNSL patients treated with three different HD-MTX-based combinations. Anticonvulsants were administered in 31 pts (69%). Age >60 years, anticonvulsant therapy, slow IRMTX (≤800 mg m -2h-1), and reduced DIMTX (≤ 1000 mg m -2wk-1) were significantly correlated with low AUC MTX values, Seven patients (16%) experienced severe toxicity, which was independently associated with slow CLcrea. A total of 18 (40%) patients achieved complete remission after chemotherapy, which was independently associated with slow CLcrea. In all, 22 patients were alive at a median follow-up of 31 months, with a 3-year OS of 40 ± 9%; slow CLcrea and AUCMTX > 1100 μmol h l-1 were independently associated with a better survival. Slow CLcrea and high AUCMTX are favourable outcome-determining factors in PCNSL, while slow CLcrea is significantly related to higher toxicity. AUCMTX significantly correlates with age, anticonvulsant therapy, IRMTX, and DIMTX. These findings, which seem to support the choice of an MTX dose ≥ 3 g m-2 in a 4-6-h infusion, every 3-4 weeks, deserve to be assessed prospectively in future trials. MTX dose adjustments in patients with fast CLcrea should be investigated.
KW - Area under the curve
KW - Chemotherapy
KW - Dose intensity
KW - Methotrexate
KW - Plasmatic clearance
KW - Primary central nervous system lymphoma
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UR - http://www.scopus.com/inward/citedby.url?scp=10744231543&partnerID=8YFLogxK
U2 - 10.1038/sj.bjc.6601472
DO - 10.1038/sj.bjc.6601472
M3 - Article
C2 - 14735176
AN - SCOPUS:10744231543
VL - 90
SP - 353
EP - 358
JO - British Journal of Cancer
JF - British Journal of Cancer
SN - 0007-0920
IS - 2
ER -