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Outcome of an Elderly Female With Diffuse Large B-cell Lymphoma With Central Nervous System and Orbital Involvement Treated With Modified Methotrexate and R-CHOP Therapy: A Case Report.

Brain tumor research and treatment 2026 Vol.14(1) p. 47-51

de la Paz FGE, Opinaldo PVA, Imperial MALV

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The National Comprehensive Cancer Network (NCCN) recommends a regimen of rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) with methotrexate (MTX) given at ≥3 g/m² for stage IV diffuse

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APA de la Paz FGE, Opinaldo PVA, Imperial MALV (2026). Outcome of an Elderly Female With Diffuse Large B-cell Lymphoma With Central Nervous System and Orbital Involvement Treated With Modified Methotrexate and R-CHOP Therapy: A Case Report.. Brain tumor research and treatment, 14(1), 47-51. https://doi.org/10.14791/btrt.2025.0004
MLA de la Paz FGE, et al.. "Outcome of an Elderly Female With Diffuse Large B-cell Lymphoma With Central Nervous System and Orbital Involvement Treated With Modified Methotrexate and R-CHOP Therapy: A Case Report.." Brain tumor research and treatment, vol. 14, no. 1, 2026, pp. 47-51.
PMID 41663202

Abstract

The National Comprehensive Cancer Network (NCCN) recommends a regimen of rituximab, cyclophosphamide, doxorubicin, and prednisone (R-CHOP) with methotrexate (MTX) given at ≥3 g/m² for stage IV diffuse large B-cell lymphoma with parenchymal involvement. Tumor lysis syndrome (TLS) may occur after initiation of treatment. MTX, though beneficial, may induce toxicity, especially in elderly patients with comorbidities. This paper discusses a case of 74-year-old female with secondary central nervous system lymphoma with multiple comorbidities and high risk for TLS given a modified schedule of R-CHOP and a lower dose of MTX at 2-2.5 g/m² with a good treatment response. This paper aims to contribute additional information on optimal treatment for this disease.