MONDAY, Sept. 21 (HealthDay News) -- The addition of high-dose cytarabine to standard methotrexate treatment of primary central nervous system lymphomas greatly improves remission rates, according to a study published early online Sept. 20 in The Lancet to coincide with the European Cancer Organisation meeting in Berlin.

As part of an open Phase II trial, Andres J.M. Ferreri, M.D., from the San Raffaele Scientific Institute in Milan, Italy, and colleagues randomly assigned 79 adults with non-Hodgkin lymphoma confined to the central nervous system, cranial nerves, or eyes to methotrexate alone or combined with cytarabine. Both treatments were accompanied by whole-brain irradiation in most cases.

After a median follow-up of 30 months, the researchers found that the complete remission rate was significantly higher in patients who received both drugs (46 versus 18 percent). After including patients with a partial response, the overall response rate remained significantly higher in the methotrexate plus cytarabine group (69 versus 40 percent). Significantly more patients in the combination group had grade 3 to 4 hematological toxicity (92 versus 15 percent), although the death rate from toxicity was not significantly different (8 versus 3 percent).

"In conclusion, the addition of high-dose cytarabine to high-dose methotrexate is associated with a remarkable outcome benefit in patients with primary central nervous system lymphoma," Ferreri and colleagues conclude. "This combination could be used as an upfront approach in patients aged 75 years and younger and with adequate hepatic and renal function, with appropriate antimicrobial prophylaxis."

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