Rituximab therapy for CNS lymphomas: targeting the leptomeningeal compartment

JL Rubenstein, D Combs, J Rosenberg… - Blood, The Journal …, 2003 - ashpublications.org
JL Rubenstein, D Combs, J Rosenberg, A Levy, M McDermott, L Damon, R Ignoffo, K Aldape
Blood, The Journal of the American Society of Hematology, 2003ashpublications.org
Most lymphomas that involve the central nervous system are B-cell neoplasms that express
the cell surface molecule CD20. After intravenous administration, rituximab can be
reproducibly measured in the cerebrospinal fluid (CSF) in patients with primary central
nervous system lymphoma; however, the CSF levels of rituximab are approximately 0.1% of
serum levels associated with therapeutic activity in patients with systemic non-Hodgkin
lymphoma. Because lymphomatous meningitis is a frequent complication of non-Hodgkin …
Most lymphomas that involve the central nervous system are B-cell neoplasms that express the cell surface molecule CD20. After intravenous administration, rituximab can be reproducibly measured in the cerebrospinal fluid (CSF) in patients with primary central nervous system lymphoma; however, the CSF levels of rituximab are approximately 0.1% of serum levels associated with therapeutic activity in patients with systemic non-Hodgkin lymphoma. Because lymphomatous meningitis is a frequent complication of non-Hodgkin lymphoma, we have conducted an analysis of the safety and pharmacokinetics of direct intrathecal administration of rituximab using cynomolgus monkeys. No significant acute or delayed toxicity, neurologic or otherwise, was detected. Pharmacokinetic analysis suggests that drug clearance from the CSF is biphasic, with a terminal half-life of 4.96 hours. A phase 1 study to investigate the safety and pharmacokinetics of intrathecal rituximab in patients with recurrent lymphomatous meningitis will be implemented based on these findings.
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