Recurrent lymphomatous meningitis treated with intra-CSF rituximab and liposomal ara-C

Background The most frequent central nervous system complication of systemic non-Hodgkin’s lymphoma (NHL) is lymphomatous meningitis (LM). Objective A clinical series to test the feasibility of combining intra-CSF liposomal ara-C and rituximab for the treatment of recurrent LM. Design Clinical series of 14 patients with CSF positive lymphomatous meningitis. Setting Tertiary-care university medical center. Results Fourteen patients with recurrent, cytologically positive lymphomatous meningitis were treated. All 14 received liposomal ara-C and rituximab utilizing an Ommaya reservoir. Six patients also received involved-field radiotherapy (brain only two patients; brain and spine two patients; spine only two patients). Best response to treatment included 10 partial responses and four with progressive disease. Estimated median duration of response was 4.0 months (range 1–6 months). Survival ranged from 1.5 to 7 months with an estimated median of 5 months, four patients remain alive and continue to be followed. Cause of death was progressive neurological disease in 7, systemic disease in 1, and combined systemic and neurological disease in 2 patients. Conclusions The combination of intra-CSF liposomal ara-C and rituximab administered in this schedule appears to have no additive toxicity and has modest palliative activity in patients with recurrent LM.