Rituximab, methotrexate, procarbazine and lomustine (R-MPL) for the treatment of primary Central nervous system lymphoma

Eyal Lebel*, Neta Goldschmidt, Tali Siegal, Alexander Lossos, Shai Rosenberg, Chen Makranz, Eduard Linetski, Moshe E. Gatt, Alexander Gural, Revital Saban, David Lavie, Vladimir Vainstein, Eran Zimran, Batia Avni, Sigal Grisaro, Adir Shaulov, Boaz Nachmias

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

3 Scopus citations


The optimal high-dose methotrexate (HDMTX)-based combination therapy for primary central nervous system lymphoma is unknown. We report our experience with rituximab, HDMTX, procarbazine and lomustine (R-MPL) given as first-line treatment in our center. Fifty-two patients between 2006 and 2019 were included. Eighteen patients proceeded to autologous transplant or two cycles of intermediate-dose cytarabine. The median age was 62 y (range 28–94) and the Eastern Cooperative Oncology Group performance status (ECOG-PS) was ≥2 in 62% (32/52). The overall/complete response rates were 79% (41/52) and 52% (27/52), respectively. The median progression-free/overall survival was 19 m/84m, respectively. Grade 3–4 adverse events included infections (17%) and kidney injury (13%). Ten patients (19%) discontinued therapy for toxicity. There were no treatment-related deaths. In summary, in a cohort enriched in frail patients, R-MPL achieved good responses and OS and was safe for all ages. The PFS was sub-optimal, possibly explained by a low proportion of consolidation. This regimen should be evaluated prospectively.

Original languageAmerican English
Pages (from-to)2102-2108
Number of pages7
JournalLeukemia and Lymphoma
Issue number9
StatePublished - Sep 2022

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  • Primary CNS lymphoma
  • lomustine
  • methotrexate
  • procarbazine


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