Methotrexate Procarbazine Vincristine MPV

MPV, a regimen combining HD-MTX, procarbazine, and vincristine has been reported by several groups, including a large multicenter Radiation Therapy Oncology Group (RTOG) trial as having excellent response and survival when used in combination with WBRT [51-53].

Pre-RT MPV chemotherapy consists of MTX 2.5-3.5 g/m2 infused over two hours given every other week for a total of five doses. Vincristine 1.4 mg/m2 (maximum dose, 2.8 mg) is given concomi-tantly with each cycle of systemic MTX. Procarbazine 100 mg/m2/day for seven days is given with the first, third, and fifth cycle of MTX. Intra-Ommaya MTX (12 mg) is given weekly on alternate weeks after administration of systemic MTX, if initial CSF cytology is positive. Leucovorin rescue, aggressive hydration, and alkalinization are started 24 h following the MTX infusion. Chemotherapy is followed by 45 Gy of whole-brain RT. All patients with evidence of ocular lymphoma should receive 30-40 Gy of ocular RT.

FIGURE 28.1 Treatment Algorithm for Newly Diagnosed PCNSL.

Three weeks after the completion of WBRT, patients receive two courses of high-dose cytarabine; each course consists of two doses of 3 g/m2 infused over three hours separated by 24 h [51].

The same regimen was used with different MTX doses in two trials. The RTOG trial used 2.5 g/m2 of MTX per cycle and a European confirmatory trial of MPV used 3 g/m2 with similar response rates but shorter median overall survival (Table 28.3) [52,53]. The optimal number of cycles of MPV or other HD-MTX-based regimens is not known, but a

TABLE 28.3 MPV Regimens

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