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High-dose methotrexate is beneficial in parenchymal brain masses of uncertain origin suspicious for primary CNS lymphoma

Department of Hematology, Oncology, and Transfusion Medicine (P.K., M.R., E.T., A.K.) and Department of Pathology (C.L., I.A.), Charité Campus Benjamin Franklin, 12200 Berlin, Germany

¹ Address correspondence to Philipp Kiewe, Department of Hematology, Oncology, and Transfusion Medicine, Charité Campus Benjamin Franklin, Hindenburgdamm 30/31, 12200 Berlin, Germany (philipp.kiewe{at}charite.de).

In patients with parenchymal brain masses of uncertain origin responsive to corticosteroids, primary CNS lymphoma (PCNSL) should be considered. PCNSL is a rare but aggressive brain tumor that is highly sensitive to high-dose methotrexate (HDMTX)-based chemotherapy. We report a series of six patients with brain masses without histologic confirmation suspicious for PCNSL based on clinical and radiomorphologic criteria after exclusion of some infectious conditions. All patients were treated with HDMTX. We observed two complete responses, two partial responses, and one stable disease. One patient had progressive disease and received rescue whole-brain irradiation. All patients were alive without disease progression 12-48 months after HDMTX start. No symptoms of late neurotoxicity have occurred so far. The response and survival data in this small series of patients are encouraging and suggest a benefit for patients with suspected PCNSL after initial treatment with HDMTX.

Key Words: brain masses • brain tumor • CNS lymphoma • high-dose methotrexate • unconfirmed diagnosis • unconfirmed histology

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