Ifosfamide for intraocular lymphoma

Abstract

1520 Background: Intraocular lymphoma (IOL) occurs as a manifestation of a primary central nervous system lymphoma (PCNSL) or as ocular involvement of a systemic lymphoma. The treatment of IOL has not yet been defined, since the data has been limited to small, usually retrospective treatment series or case reports. CNS relapse is the rule after local treatment modalities. Ifosfamide is administered intravenously (IV) or orally (PO) as the main metabolite of trofosfamide. Its penetration into the eye has never been evaluated but is assumed based on its ability to penetrate the CNS. Methods: We treated 4 patients (pts) with bilateral IOL confirmed by vitrectomy and/or chorioretinal biopsy. Patient (pt) 1, a 83-year-old woman with newly diagnosed primary IOL and multiple comorbidities, refused radiotherapy (RT). Pt 2, a 46-year-old man, had a PCNSL resistant to 3 chemotherapy regimens and relapsed after RT in both eyes. Pt 3, a 77-year-old man, had secondary IOL due to newly diagnosed immunocytoma. Pt 4, a 52-year-old man, had an intraocular relapse of PCNSL after high-dose methotrexate and RT. Pts 1 and 2 received either 150 mg or 400 mg/day of trofosfamide PO on days 1–5 followed by a five-day drug-free interval. Pts 3 and 4 received either 2,000 or 1,500 mg/m2/day of ifosfamide IV days 1–3. Concentrations of ifosfamide and its active metabolite, 4-hydroxy-ifosfamide, were measured in the serum and anterior chamber of the eye in pt 4. Results: According to fundoscopy, pts 1–3 achieved complete remission at 7+, 18 and 3+ months, which was accompanied by a significant increase in visual acuity (VA). Pt 4, who is still under treatment, had a partial remission after one cycle with VA normalization. The 4-hydroxy-ifosfamide concentration in the anterior chamber of the eye was 2.39 μmol/l (54 % of the corresponding serum concentration) directly after the 2-hour infusion. No significant therapy-related side effects were noted in all pts. Conclusions: Ifosfamide seems to be active in IOL with a favorable side effect profile. Trofosfamide can be administered on an outpatient basis. The eye was significantly penetrated by 4-hydroxy-ifosfamide. No significant financial relationships to disclose.