methotrexate IV

The patient initially received 2 cycles of rituximab combined with high-dose methotrexate chemotherapy...Subsequently, the regimen was adjusted to 6 cycles of cytarabine combined with temozolomide chemotherapy followed by radiotherapy for the intracranial lesion...Up to the date of follow-up, the patient's condition was stable without recurrence. Combined with literature review, this article discusses the possible mechanisms of the coexistence of dual-subtype DLBCL (clonal evolution or biclonal origin), the potential pathways of temporal muscle metastasis and the impact of subtype differences on treatment response, which provides clinical reference for the diagnosis and individualized treatment of such rare cases.

Therefore, we upgraded the treatment plan to R-CHOP chemotherapy (rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone), and achieved a complete remission (CR)...We observe that the combination of HD-MTX and intrathecal chemotherapy exhibits remarkable efficacy in managing post-transplant CNS-PTLD that is resistant to conventional R-CHOP chemotherapy. CAR-T therapy emerges as a potential option for patients suffering from relapsed or refractory CNS-PTLD.

In contrast, chemotherapy-induced seizures, particularly those associated with high-dose methotrexate, arise from disrupted folate metabolism, intracellular oxidative stress, and subsequent N-methyl-D-aspartate (NMDA) receptor-mediated excitotoxicity. We provide a comparative analysis of these pathways, integrating current evidence on pharmacogenomic susceptibility-including polymorphisms in methylenetetrahydrofolate reductase (MTHFR) and drug transporter genes-as well as epigenetic factors. By synthesizing these molecular insights, we propose a mechanistic framework for precise clinical differentiation, which may inform biomarker-driven diagnostic approaches and targeted neuroprotective strategies in this vulnerable population.

ASCT was associated with the most durable survival among consolidation strategies after R-MVP induction. These findings, derived from a large real-world, multi-institutional cohort, support ASCT as the preferred consolidation for eligible patients while underscoring the heterogeneity of current practice and the need for prospective validation.

The patient received high-dose methotrexate-based chemotherapy according to the DeAngelis protocol, combined with rituximab, selected to optimise disease control while minimising the neurotoxicity associated with whole-brain radiotherapy. She achieved visual recovery to 6/9 and regression of the central nervous system (CNS) lesion. This case underscores the importance of recognising pathognomonic retinal signs and employing molecular immunophenotyping to enable timely, life-saving, neuro-sparing therapy.

P1, N=47, Recruiting, National Cancer Institute (NCI) | Trial completion date: May 2026 --> Apr 2027 | Trial primary completion date: May 2026 --> Apr 2027

In elderly PCNSL patients, R-MPV without routine WBRT provides effective disease control while being associated with less structural brain change. CSF IL-10 may represent a potential biomarker of susceptibility to treatment-related brain structural alterations.

Given persistent cholestasis and bleeding risk, the patient underwent Roux-en-Y choledochojejunostomy for biliary decompression, followed by initiation of rituximab-cyclophosphamide-vincristine-doxorubicin-high-dose methotrexate/rituximab-ifosfamide-etoposide-high-dose cytarabine (R-CODOX-M/R-IVAC) with central nervous system prophylaxis...Ampullary BL should be considered in pediatric patients with obstructive jaundice and upper gastrointestinal bleeding. Surgical biliary decompression can stabilize cholestasis and facilitate timely multi-agent chemotherapy.

However, epcoritamab induced a rapid systemic response along with partial neurological improvement. This case highlights the potential role of bispecific antibody therapy in refractory DLBCL with CNS involvement, an area of significant unmet clinical need.

P2, N=227, Completed, International Extranodal Lymphoma Study Group (IELSG) | N=126 --> 227

P3, N=200, Recruiting, Children's Cancer Group, China | Trial primary completion date: Dec 2025 --> Dec 2026

P2, N=16, Recruiting, Wake Forest University Health Sciences | Trial completion date: Jan 2027 --> Jul 2027