Patients with end stage renal disease usually do not receive high dose methotrexate therapy due to concerns for increased risk for adverse effects, including bone marrow suppression and mucositis. High dose methotrexate therapy is the standard of care for management of CNS lymphoma, both primary and secondary as well as for managing post-transplant lymphoproliferative disorders (PTLD) involving the CNS. These approaches have not been studied in ESRD, and there is growing interest in developing innovative strategies that enable safe high dose methotrexate (HDMTX) administration in patients with ESRD undergoing hemodialysis. We report the outcomes of two patients with primary CNS lymphoma (PCNSL) on HD who received high dose methotrexate with different dosing strategies. Both patients tolerated treatment well and continue to do well at follow up.
Zafar et al. (Thu,) studied this question.