Department of Hematology, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyoku, Tokyo, Japan.
Int J Hematol. 2010 Jul;92(1):179-85. doi: 10.1007/s12185-010-0589-6. Epub 2010 May 13.
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 muM), 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.
眼内淋巴瘤 (IOL) 是一种罕见的淋巴瘤，常侵犯中枢神经系统 (CNS)。目前尚未确立最佳治疗方法，其预后相当差。我们采用静脉和玻璃体内甲氨蝶呤 (MTX) 注射联合治疗 3 例中枢神经系统受累的 IOL 患者。所有患者的眼内病变均有反应。1 例患者达到完全缓解 (CR)，而另外 2 例中枢神经系统病变部分缓解，加行全脑放疗后达到 CR。2 例患者的 3 只眼在全身 MTX 注射 (sMTX) 后 2 小时内进行玻璃体内 MTX 注射 (vMTX)，并在两次测量玻璃体内 MTX 浓度：sMTX 后 2 小时和 vMTX 后 24 小时。假设为一级消除动力学，MTX 在玻璃体内的半衰期估计为 12.4-21.5 小时。尽管 vMTX 后 24 小时浓度仍较高 (69.94-82.89 μM)，但无眼部并发症。添加 vMTX 不会影响血清 MTX 浓度。仅 1 例患者观察到 3 级不良事件，白细胞减少症。未观察到 4 级事件。尽管需要进一步评估，但同时使用 sMTX 和 vMTX 可能对 CNS 受累的 IOL 有效。
