Intrathecal Rituximab for Treatment of Leptomeningeal NonHodgkin’s Lymphoma: A Case Report

Abstract

Introduction: Standard therapy for central nervous system (CNS) Non-Hodgkin’s lymphoma (NHL) is still to be determined and varies in clinical practice. Leptomeningeal metastasis (LM) is more common as compared to parenchymal disease in CNS NHL. We present a case of Leptomeningeal NHL which was found to be resistant to treatment with intrathecal (IT) Methotrexate, Cytarabine and whole brain radiation therapy (WBRT). Our patient achieved a complete remission only after treatment with IT Rituximab.
Case Presentation: 74-year-old male presented to us with cough with purulent sputum. Upon thorough investigation including biopsy of axillary lymphadenopathy and a staging MRI, the patient was found to have low grade I/III B cell follicular lymphoma with LM. The patient was refractory to treatment with intrathecally dministered Methotrexate, intrathecal (IT) Cytarabine and WBRT. After administration of IT Rituximab, patient showed clinical improvement and subsequent cerebrospinal fluid (CSF) cytology revealed complete elimination of clonal B-cell population.
Conclusions: In LM where cure is generally not expected, administration of IT Rituximab showed a favorable efficacy and safety profile. Prospective trials are needed to establish the role of IT Rituximab as a standard of care for treatment of LM involvement in B-cell lymphomas.