CNS lymphoma
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High-dose Methotrexate (MTX) & Ifosfamide
Regimen
- Methotrexate (MTX) 4000 mg/m2 IV over 4 hours on day 1
- Ifosfamide (Ifex) 1500-2000 mg/m2 IV over 3 hours on days 3-5
- Mesna (Mesnex) for prophylaxis of hemorrhagic cystitis
- Folinic acid (Leucovorin) rescue starting 24 hours after start of methotrexate infusion
- Sodium bicarbonate via IV fluid or PO routes used for urine alkalinization to maintain urine pH of at least 8
- Check methotrexate levels 24, 48, and 72 hours after completion of methotrexate infusion.
Methotrexate (MTX) dose adjusted for creatinine clearances <100 mL/min according to the following formula:
- Dose of methotrexate = (creatinine clearance/100) x 4000 mg/m2; the paper did not specify what method was used for calculating creatinine clearance. Patients with creatinine clearance <50 mL/min were excluded from the study.
up to 8 cycles (reference did not list timing/criteria to be used for next cycle of therapy)
References
- Fischer L, Korfel A, Kiewe P, Neumann M, Jahnke K, Thiel E. Systemic high-dose methotrexate plus ifosfamide is highly effective for central nervous system (CNS) involvement of lymphoma. Ann Hematol. 2009 Feb;88(2):133-9. Epub 2008 Aug 5. link to original article contains verified protocol PubMed