Our patient was discussed at MDT and as many have suggested, he is treated with intensive chemotherapy.
MATRIX – HD MTX, cytarabine, thiotepa and rituximab is the current regime recommended in the UK. Intrathecal chemotherapy is not advocated in the BSH guidelines. MTX should be delivered at doses of at least 3g/m2 with an infusion time of 2-4 hours.
He had a repeat MRI after two cycles showing complete remission. His stem cells were harvested after the second cycle. He goes onto to have a further 2 cycles of MATRIX followed by autologous stem cell transplant.
Repeat MRI at 6 weeks following treatment shows no evidence of disease. However 5 months following ASCT he presents with slurred speech and further MRI shows two new cerebral lesions.
What is your differential? Management plan?