Induction with rituximab, methotrexate, ifosfamide, and vincristine (R-MIV) for the treatment of primary central nervous system lymphoma (PCNSL) was effective with an acceptable safety profile, according to the results of a study published in the British Journal of Haematology.

The standard induction treatment of PCNSL includes cytarabine; however, this agent is associated with high hematologic toxicity and delayed SARS-CoV-2 clearance and higher risk of COVID-19 pneumonia. The aim of this study was to evaluate an induction regimen without cytarabine.

In the study, 64 patients with newly-diagnosed PCNSL were treated with R-MIV for induction therapy. The primary endpoint was overall response rate (ORR), with secondary endpoints including overall survival (OS) and progression-free survival (PFS). The median follow-up was 44.3 months.

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The median age at baseline was 59, 50% of patients were male, and the performance status was 0-1 among 42%, 2 among 36%, and 3 among 22%. There were 59% of patients with multiple lesions and 54.7% with deep lesions. Prior to treatment and after biopsy, 19% of patients were in complete remission post steroids, 22% showed progression, and 59% were stable.

The ORR was 73% based on an MRI/CT assessment, which included 46% of patients who achieved a complete response. With a FDG-PET/CT evaluation, the ORR was 85.5%. There were 8% of patients who experienced disease progression prior to transitioning to consolidation therapy. There were 78% of patients who were eligible for consolidation therapy.

The PFS at 2 years was 64.9% and the OS was 66.3%. Although the R-MIV regimen was well-tolerated, there were 3 deaths related to toxicity during induction. Grade 3-4 neutropenia occurred among 25% of patients, thrombocytopenia among 1%, and anemia among 3.5%. The authors concluded that “the R-MIV regimen is feasible in routine practice, effective and safe.”

Disclosures: Some of the study authors declared affiliations with biotech, pharmaceutical, or device companies. Please see the original reference for a full list of disclosures.


Ostrowska B, Domanska-Czyz K, Romejko-Jarosinska J, et al. Safety and efficacy of induction immunochemotherapy with rituximab, methotrexate, ifosfamide, and vincristine (R-MIV) in patients with primary CNS lymphoma including recent COVID-19 pandemic experience. Br J Haematol. Published online February 10, 2023. doi: 10.1111/bjh.18687

This article originally appeared on Hematology Advisor