Treatment of recurrent primary CNS lymphoma (PCNSL) though not standardized most often utilizes whole brain radiotherapy, re-challenge with high-dose methotrexate, or administration of an alkylating chemotherapy. High-dose cytarabine (HD-araC) has been advocated as an active agent in PCNSL but limited information exists regarding single agent activity in the recurrent setting. A retrospective review of 14 patients (10 males, 4 females: median age 60 years) with recurrent PCNSL treated at second recurrence with single agent HD-araC. HD-araC was administered at 3gm/m2 over a 3-h infusion every 12 h for a total of 4 doses (defined as a cycle of therapy). GM-CSF was administered at conclusion of HD-araC. Patients were clinically and radiographically evaluated every 4-weeks. Common toxicity criteria Grade 3 or 4 toxicity included thrombocytopenia (11 patients; 79 %), anemia (10; 71 %), fatigue (8; 57 %), mucositis (8; 57 %), neutropenia (8; 57 %) and neutropenic fever (5; 36 %). No patient discontinued therapy due to toxicity nor were there any treatment-related deaths. Best response to HD-araC was stable disease in 6 patients (43 %), partial response in 5 (36 %) and progressive disease in 3 (21 %). Median progression free survival 3 months (range 2–5 months; 95 % CI 2–4 months) and progression free survival was 0 % at 6-months. Median survival after onset of HD-araC was 12 months (range 3–18+ months; 95 % CI 3–15 months). Single agent HD-araC has limited activity in recurrent PCNSL and is associated with significant toxicity in this small retrospective study.
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