What is the role of methotrexate in the treatment of primary central nervous system lymphoma (PCNSL)?

Updated: Jan 19, 2018
  • Author: Tarakad S Ramachandran, MBBS, MBA, MPH, FAAN, FACP, FAHA, FRCP, FRCPC, FRS, LRCP, MRCP, MRCS; Chief Editor: Stephen A Berman, MD, PhD, MBA  more...
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Methotrexate-based chemotherapy regimens have been the most successful treatment strategies to date. Methotrexate is a folate analogue that interferes with DNA synthesis and repair. For treatment of PCNSL, patients receive high-dose systemic methotrexate. This is because when the drug is administered in high doses systemically, it achieves therapeutic levels in brain parenchyma and obviates intrathecal therapy as an initial treatment for PCNSL.

Close monitoring and adjustment of IV fluids and calcium leucovorin rescue necessitates inpatient administration of this drug.

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