methotrexate + cyclophosphamide + etoposide phosphate (OHSU BBBD protocol)

The OHSU BBBD protocol is a specialized multi-agent chemotherapy regimen developed by the OHSU Knight Cancer Institute specifically for the treatment of primary central nervous system lymphoma (PCNSL). The protocol, pioneered by Dr. Edward Neuwelt, utilizes osmotic blood-brain barrier disruption (BBBD) to overcome the physiological barriers that typically limit the penetration of systemic chemotherapy into the brain. The procedure involves the intra-arterial administration of hyperosmotic mannitol to temporarily open the blood-brain barrier, followed by the delivery of methotrexate, cyclophosphamide, and etoposide phosphate. This approach can achieve 50- to 100-fold higher drug concentrations in the brain parenchyma compared to standard intravenous delivery. The regimen is often supplemented with intraventricular cytarabine and systemic dexamethasone to provide comprehensive CNS coverage and manage inflammation.

Other names

BBBD chemotherapyOHSU BBBD protocolNeuwelt protocolBBBD Chemotherapy for Primary CNS Lymphoma