High-Dose Methotrexate and Primary Central Nervous System Lymphoma
High-Dose Methotrexate and Primary Central Nervous System Lymphoma
Primary central nervous system lymphoma (PCNSL) is a rare disease that is managed differently from other primary brain tumors and other types of systemic lymphomas. The use of high-dose methotrexate (HD-MTX) has improved survival rates. This article describes the experience of a patient treated with HD-MTX and outlines the essential aspects of care for the bedside practitioner. An understanding of the diagnostic workup and principles of treatment can minimize complications and maximize patient function as nurses care for the unique physical and emotional needs of this population.
Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin's lymphoma (NHL) confined to the nervous system. The disease is managed quite differently from other primary brain tumors or systemic NHL. Unlike many primary brain tumors, PCNSL is responsive to treatment, and aggressive management may lead to prolonged remission or cure (Lister, Abrey, & Sandlund, 2002). The use of high-dose methotrexate (HD-MTX), 8 g/m, for PCNSL has greatly increased median survival rates (DeAngelis & Hormingo, 2004; Plotkin & Batchelor, 2001; Yamanaka & Tanaka, 2004). Although whole-brain radiotherapy results in responses of more than 90%, radiation therapy is associated with high relapse rates and delayed neurotoxicity (Correa et al., 2003). HD-MTX used alone is associated with significantly fewer treatment-associated toxic side effects (DeAngelis & Hormingo; Plotkin & Batchelor; Yamanaka & Tanaka).
Methotrexate is an antimetabolite that penetrates the blood brain barrier when given in high doses intravenously. MTX exerts its chemotherapeutic effect by counteracting and competing with folic acid in cancer cells, resulting in folic acid deficiency and cell death. Normal cells are not spared; thus, significant side effects can occur.
The care of the patient treated with HD-MTX requires nurses fluent in both the neuroscience assessment and the principles of cancer care. The timely recognition of signs of increasing intracranial pressure or specific neurological deficits can minimize and perhaps prevent neurological complications. The hazards of HD-MTX administration involve identifying the systemic complications and managing the side effects associated with chemotherapy. This article presents a case study of a patient with PCNSL treated with HD-MTX.
Abstract and Introduction
Abstract
Primary central nervous system lymphoma (PCNSL) is a rare disease that is managed differently from other primary brain tumors and other types of systemic lymphomas. The use of high-dose methotrexate (HD-MTX) has improved survival rates. This article describes the experience of a patient treated with HD-MTX and outlines the essential aspects of care for the bedside practitioner. An understanding of the diagnostic workup and principles of treatment can minimize complications and maximize patient function as nurses care for the unique physical and emotional needs of this population.
Introduction
Primary central nervous system lymphoma (PCNSL) is a rare type of non-Hodgkin's lymphoma (NHL) confined to the nervous system. The disease is managed quite differently from other primary brain tumors or systemic NHL. Unlike many primary brain tumors, PCNSL is responsive to treatment, and aggressive management may lead to prolonged remission or cure (Lister, Abrey, & Sandlund, 2002). The use of high-dose methotrexate (HD-MTX), 8 g/m, for PCNSL has greatly increased median survival rates (DeAngelis & Hormingo, 2004; Plotkin & Batchelor, 2001; Yamanaka & Tanaka, 2004). Although whole-brain radiotherapy results in responses of more than 90%, radiation therapy is associated with high relapse rates and delayed neurotoxicity (Correa et al., 2003). HD-MTX used alone is associated with significantly fewer treatment-associated toxic side effects (DeAngelis & Hormingo; Plotkin & Batchelor; Yamanaka & Tanaka).
Methotrexate is an antimetabolite that penetrates the blood brain barrier when given in high doses intravenously. MTX exerts its chemotherapeutic effect by counteracting and competing with folic acid in cancer cells, resulting in folic acid deficiency and cell death. Normal cells are not spared; thus, significant side effects can occur.
The care of the patient treated with HD-MTX requires nurses fluent in both the neuroscience assessment and the principles of cancer care. The timely recognition of signs of increasing intracranial pressure or specific neurological deficits can minimize and perhaps prevent neurological complications. The hazards of HD-MTX administration involve identifying the systemic complications and managing the side effects associated with chemotherapy. This article presents a case study of a patient with PCNSL treated with HD-MTX.