High-dose cytarabine salvage therapy for recurrent primary CNS lymphoma

Treatment of recurrent primary CNS lymphoma (PCNSL) though not standardized most often utilizes whole brain radiotherapy, re-challenge with high-dose methotrexate, or administration of an alkylating chemotherapy. High-dose cytarabine (HD-araC) has been advocated as an active agent in PCNSL but limited information exists regarding single agent activity in the recurrent setting. A retrospective review of 14 patients (10 males, 4 females: median age 60 years) with recurrent PCNSL treated at second recurrence with single agent HD-araC. HD-araC was administered at 3gm/m(2) over a 3-h infusion every 12 h for a total of 4 doses (defined as a cycle of therapy). GM-CSF was administered at conclusion of HD-araC. Patients were clinically and radiographically evaluated every 4-weeks. Common toxicity criteria Grade 3 or 4 toxicity included thrombocytopenia (11 patients; 79%), anemia (10; 71%), fatigue (8; 57%), mucositis (8; 57%), neutropenia (8; 57%) and neutropenic fever (5; 36%). No patient discontinued therapy due to toxicity nor were there any treatment-related deaths. Best response to HD-araC was stable disease in 6 patients (43%), partial response in 5 (36%) and progressive disease in 3 (21%). Median progression free survival 3 months (range 2-5 months; 95% CI 2-4 months) and progression free survival was 0% at 6-months. Median survival after onset of HD-araC was 12 months (range 3-18+ months; 95% CI 3-15 months). Single agent HD-araC has limited activity in recurrent PCNSL and is associated with significant toxicity in this small retrospective study.