Concurrent administration of intravenous systemic and intravitreal methotrexate for intraocular lymphoma with central nervous system involvement
Concurrent administration of intravenous systemic and intravitreal methotrexate for intraocular lymphoma with central nervous system involvement
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DOI：
10.1007/s12185-010-0589-6
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发表时间：
2010-07-01
影响因子：
2.1
通讯作者：
Arai, Ayako
中科院分区：
文献类型：
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作者：
Nakauchi, Yusuke;Takase, Hiroshi;Arai, Ayako
眼内淋巴瘤(IOL)是一种罕见的淋巴瘤，常侵犯中枢神经系统。目前还没有确定最佳的治疗方法，其预后也很差。我们通过静脉注射和玻璃体内注射同时应用氨甲喋呤(MTX)治疗了3例伴有中枢神经系统受累的人工晶状体患者。所有患者眼内病变均有反应。1例完全缓解(CR)，2例中枢神经系统病变部分缓解，加全脑放疗后完全缓解。2例3只眼在全身注射MTX(SMTX)后2 h玻璃体腔内注射MTX，分别于注射后2 h和24 h测量玻璃体内MTX浓度。甲氨蝶呤在玻璃体中的半衰期为12.4~21.5h，符合一级消除动力学。虽然vMTX后24 h血药浓度仍较高(69.94~82.89 mU/L)，但无眼部并发症。在SMTX中加入vMTX对血清MTX浓度无明显影响。仅有1例患者观察到3级不良事件，即白细胞减少。未观察到4级事件。虽然还需要进一步的评估，但同时应用SMTX和vMTX对伴有中枢神经系统损害的IOL可能是有效的。
Intraocular lymphoma (IOL) is rare lymphoma that frequently infiltrates the central nervous system (CNS). An optimal treatment has not been established, and its prognosis is quite poor. We treated three IOL patients with CNS involvement by concurrent administration of intravenous and intravitreal methotrexate (MTX) injection. The intraocular lesion responded in all patients. One patient achieved complete response (CR), whereas the other 2 patients were in partial response for CNS lesion, added whole brain radiation and achieved CR. In 3 eyes of 2 patients, an intravitreal MTX injection (vMTX) was administered 2 h after a systemic MTX injection (sMTX) and the intravitreal MTX concentration was measured twice: 2 h after sMTX and 24 h after vMTX. The half-life of MTX in the vitreous fluid was estimated to be 12.4-21.5 h by assuming the first-order elimination kinetics. Although the concentration was still high 24 h after vMTX (69.94-82.89 mu M), there were no ocular complications. The serum MTX concentration was not influenced by adding vMTX to sMTX. Grade 3 adverse event, leukocytopenia, was observed in only 1 patient. No grade 4 event was observed. Although further evaluation is required, concurrent sMTX and vMTX may be effective for IOL with CNS involvement.