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Case Report
Online Published: 29 Oct 2026
 
RMJ. 2026; 51(4): 1187-1190

doi: 10.5455/rmj.20260605020949


Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate

Angelina Yuwono, Andri Iskandar Mardia, Anggi Saktina Sari Batubara, Heny Syahrini Lubis, Dairion Gatot.


Abstract
Primary central nervous system lymphoma (PCNSL) is a rare and aggressive extranodal non-Hodgkin lymphoma confined to the central nervous system. High-dose methotrexate (HD-MTX) is the mainstay of therapy due to its ability to penetrate the blood–brain barrier, yet disease relapse remains common. The addition of rituximab (R) has been investigated to improve treatment outcomes. We report two cases of PCNSL. The first case was a 69-year-old man who achieved near-complete remission after six cycles of HD-MTX in 2021 and remained stable for 36 months. Relapse occurred and was managed with R-HD-MTX, and whole-brain radiation. The second case was a 53-year-old man who received R-HD-MTX following tumor resection. Follow-up MRI at 3, 6, and 9 months demonstrated complete remission. These cases demonstrate the heterogeneous response of PCNSL to R-HD-MTX therapy, ranging from complete remission to initial remission followed by relapse.

Key words: primary CNS lymphoma, high-dose methotrexate, rituximab, relapse, remission.


 
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How to Cite this Article
Pubmed Style

Yuwono A, Mardia AI, Batubara ASS, Lubis HS, Gatot D. Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate. RMJ. 2026; 51(4): 1187-1190.

doi:10.5455/rmj.20260605020949

Web Style

Yuwono A, Mardia AI, Batubara ASS, Lubis HS, Gatot D. Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate. https://www.rmj.org.pk/?mno=323302 [Access: November 11, 2026].

doi:10.5455/rmj.20260605020949

AMA (American Medical Association) Style

Yuwono A, Mardia AI, Batubara ASS, Lubis HS, Gatot D. Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate. RMJ. 2026; 51(4): 1187-1190.


doi:10.5455/rmj.20260605020949

Vancouver/ICMJE Style

Yuwono A, Mardia AI, Batubara ASS, Lubis HS, Gatot D. Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate. RMJ. (2026), [cited November 11, 2026]; 51(4): 1187-1190.


doi:10.5455/rmj.20260605020949

Harvard Style

Yuwono, A., Mardia, . A. I., Batubara, . A. S. S., Lubis, . H. S. & Gatot, . D. (2026) Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate. RMJ, 51 (4), 1187-1190.


doi:10.5455/rmj.20260605020949

Turabian Style

Yuwono, Angelina, Andri Iskandar Mardia, Anggi Saktina Sari Batubara, Heny Syahrini Lubis, and Dairion Gatot. 2026. Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate. Rawal Medical Journal, 51 (4), 1187-1190.


doi:10.5455/rmj.20260605020949

Chicago Style

Yuwono, Angelina, Andri Iskandar Mardia, Anggi Saktina Sari Batubara, Heny Syahrini Lubis, and Dairion Gatot. "Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate." Rawal Medical Journal 51 (2026), 1187-1190.


doi:10.5455/rmj.20260605020949

MLA (The Modern Language Association) Style

Yuwono, Angelina, Andri Iskandar Mardia, Anggi Saktina Sari Batubara, Heny Syahrini Lubis, and Dairion Gatot. "Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate." Rawal Medical Journal 51.4 (2026), 1187-1190. Print.


doi:10.5455/rmj.20260605020949

APA (American Psychological Association) Style

Yuwono, A., Mardia, . A. I., Batubara, . A. S. S., Lubis, . H. S. & Gatot, . D. (2026) Heterogeneous treatment response in primary central nervous system lymphoma: Two cases treated with rituximab and high-dose methotrexate. Rawal Medical Journal, 51 (4), 1187-1190.


doi:10.5455/rmj.20260605020949

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