Comparison of Various Treatment Modalities in Patients with Primary Vitreoretinal Lymphoma: A Systematic Review and Meta-analysis

Overview

Journal Clin Exp Ophthalmol

Specialty Ophthalmology

Date 2024 Sep 24

PMID 39317661

Authors

Michael Ostrovsky

Tal Corina Sela

Zohar Habot-Wilner

Affiliations

Soon will be listed here.

Abstract

Background: This systematic review and meta-analysis investigated different treatment modalities' effect on the risk of central nervous system lymphoma progression, ocular disease relapse, systemic lymphoma development and overall survival in primary vitreoretinal lymphoma patients.

Methods: PubMed, EMBASE, Scopus and the Cochrane Library of clinical trials were searched from inception to April 21, 2024. Cohort, cross-sectional and case series studies were included. Methodological quality was assessed using the NIH quality assessment tools. Heterogeneity between studies was assessed using Chi square test and I statistic. Outcomes were pooled as odds ratios (OR) using fixed-effects models. Risk of publication bias was assessed using a funnel plot.

Results: Included were 28 studies with 476 participants. Ocular treatments included intravitreal methotrexate and/or rituximab injections and ocular radiotherapy. Systemic treatments included intravenous and/or intrathecal chemotherapy, whole-brain radiotherapy and autologous stem cell transplantation. Ocular treatment alone, as compared to systemic or combined treatment, resulted in significantly lower risk of central nervous system lymphoma development (OR = 0.54, p = 0.02) and in no significant difference in the risk for progression to systemic disease (OR = 0.38, p = 0.30) or in overall survival. Significantly lower risk of ocular relapse was found in patients receiving ocular or combined therapy as compared to systemic therapy alone (OR = 0.26, p = 0.001). A subgroup analysis, comparing ocular treatment alone and combined treatment, found no significant difference regarding the risk of central nervous system or systemic lymphoma progression, ocular disease relapse and overall survival.

Conclusions: No benefit was observed for the addition of systemic therapy to ocular treatment in patients with primary vitreoretinal lymphoma.

Citing Articles

Comparison of various treatment modalities in patients with primary vitreoretinal lymphoma: A systematic review and meta-analysis.

Ostrovsky M, Sela T, Habot-Wilner Z Clin Exp Ophthalmol. 2024; 53(1):84-99.

PMID: 39317661 PMC: 11790420. DOI: 10.1111/ceo.14443.

References

Page M, McKenzie J, Bossuyt P, Boutron I, Hoffmann T, Mulrow C . The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021; 372:n71. PMC: 8005924. DOI: 10.1136/bmj.n71. View

Grimm S, Pulido J, Jahnke K, Schiff D, Hall A, Shenkier T . Primary intraocular lymphoma: an International Primary Central Nervous System Lymphoma Collaborative Group Report. Ann Oncol. 2007; 18(11):1851-5. DOI: 10.1093/annonc/mdm340. View

de la Fuente M, Alderuccio J, Reis I, Omuro A, Markoe A, Echegaray J . Bilateral radiation therapy followed by methotrexate-based chemotherapy for primary vitreoretinal lymphoma. Am J Hematol. 2019; 94(4):455-460. DOI: 10.1002/ajh.25414. View

Dalvin L, Pulido J, Shields C, Marchese A, Miserocchi E, Frenkel S . Vitreoretinal lymphoma: Central nervous system lymphoma risk with unilateral or bilateral ocular tumour. A multicentre collaboration. Eye (Lond). 2022; 37(1):54-61. PMC: 9829720. DOI: 10.1038/s41433-021-01887-2. View

Berenbom A, Davila R, Lin H, Harbour J . Treatment outcomes for primary intraocular lymphoma: implications for external beam radiotherapy. Eye (Lond). 2006; 21(9):1198-201. DOI: 10.1038/sj.eye.6702437. View

Zhou N, Xu X, Liu Y, Wang Y, Wei W . A proposed protocol of intravitreal injection of methotrexate for treatment of primary vitreoretinal lymphoma. Eye (Lond). 2021; 36(7):1448-1455. PMC: 9232593. DOI: 10.1038/s41433-021-01657-0. View

Min G, Kim T, Jeon Y, O J, Choi B, Park G . Diagnosis, treatment, and prognosis of primary intraocular lymphoma: Single-center real-world clinical experience. Cancer Med. 2023; 12(7):7911-7922. PMC: 10134376. DOI: 10.1002/cam4.5567. View

Teckie S, Yahalom J . Primary intraocular lymphoma: treatment outcomes with ocular radiation therapy alone. Leuk Lymphoma. 2013; 55(4):795-801. DOI: 10.3109/10428194.2013.819576. View

Fox C, Phillips E, Smith J, Linton K, Gallop-Evans E, Hemmaway C . Guidelines for the diagnosis and management of primary central nervous system diffuse large B-cell lymphoma. Br J Haematol. 2018; 184(3):348-363. DOI: 10.1111/bjh.15661. View

10.

Hormigo A, Abrey L, Heinemann M, DeAngelis L . Ocular presentation of primary central nervous system lymphoma: diagnosis and treatment. Br J Haematol. 2004; 126(2):202-8. DOI: 10.1111/j.1365-2141.2004.05028.x. View

11.

Matsuo T, Tanaka T . Are there primary intraocular lymphomas that do not develop into central nervous system lymphomas?. J Clin Exp Hematop. 2019; 59(4):168-174. PMC: 6954168. DOI: 10.3960/jslrt.19019. View

12.

Menean M, Giuffre C, Cicinelli M, Marchese A, Modorati G, Bandello F . A comprehensive overview of diagnosis, imaging and treatment of vitreoretinal lymphoma. Eur J Ophthalmol. 2023; 34(4):931-940. PMC: 11295402. DOI: 10.1177/11206721231211931. View

13.

Castellino A, Pulido J, Johnston P, Ristow K, Bennani N, Inwards D . Role of systemic high-dose methotrexate and combined approaches in the management of vitreoretinal lymphoma: A single center experience 1990-2018. Am J Hematol. 2018; 94(3):291-298. DOI: 10.1002/ajh.25350. View

14.

Hughes P, Olejnik O, Chang-Lin J, Wilson C . Topical and systemic drug delivery to the posterior segments. Adv Drug Deliv Rev. 2005; 57(14):2010-32. DOI: 10.1016/j.addr.2005.09.004. View

15.

Mahajan S, Nijhawan R, Rajwanshi A, Karkhur S, Mulkutar S, Dogra M . Clinical Characteristics of Primary Vitreoretinal Lymphoma in an Indian Population. Ocul Immunol Inflamm. 2016; 25(5):633-638. DOI: 10.3109/09273948.2016.1139731. View

16.

Mochizuki M, Singh A . Epidemiology and clinical features of intraocular lymphoma. Ocul Immunol Inflamm. 2009; 17(2):69-72. DOI: 10.1080/09273940902957305. View

17.

Lee S, Kim M, Kim J, Oh S, Kim S, Kwon Y . Intraocular lymphoma in Korea: the Consortium for Improving Survival of Lymphoma (CISL) study. Blood Res. 2016; 50(4):242-7. PMC: 4705050. DOI: 10.5045/br.2015.50.4.242. View

18.

Klimova A, Heissigerova J, Rihova E, Brichova M, Pytlik R, Spicka I . Combined treatment of primary vitreoretinal lymphomas significantly prolongs the time to first relapse. Br J Ophthalmol. 2018; 102(11):1579-1585. DOI: 10.1136/bjophthalmol-2017-311574. View

19.

Kaburaki T, Taoka K . Diagnosis and management of vitreoretinal lymphoma: present and future treatment perspectives. Jpn J Ophthalmol. 2023; 67(4):363-381. DOI: 10.1007/s10384-023-00997-6. View

20.

Rishi P, Manchegowda P, Gondhale H, Rishi E, Das K, Krishnakumar S . Intravitreal rituximab monotherapy for management of eyes with vitreoretinal lymphoma: initial experience from India. Int Ophthalmol. 2021; 41(7):2495-2504. DOI: 10.1007/s10792-021-01805-1. View