Prophylaxis with intrathecal or high-dose methotrexate in diffuse large B-cell lymphoma and high risk of CNS relapse Journal Article
| Authors: | Bobillo, S.; Joffe, E.; Sermer, D.; Mondello, P.; Ghione, P.; Caron, P. C.; Hamilton, A.; Hamlin, P. A.; Horwitz, S. M.; Kumar, A.; Matasar, M. J.; Batlevi, C. L.; Moskowitz, A.; Noy, A.; Owens, C. N.; Palomba, M. L.; Straus, D.; von Keudell, G.; Dogan, A.; Zelenetz, A. D.; Seshan, V. E.; Younes, A. |
| Article Title: | Prophylaxis with intrathecal or high-dose methotrexate in diffuse large B-cell lymphoma and high risk of CNS relapse |
| Abstract: | Although methotrexate (MTX) is the most widely used therapy for central nervous system (CNS) prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL), the optimal regimen remains unclear. We examined the efficacy of different prophylactic regimens in 585 patients with newly diagnosed DLBCL and high-risk for CNS relapse, treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like regimens from 2001 to 2017, of whom 295 (50%) received prophylaxis. Intrathecal (IT) MTX was given to 253 (86%) and high-dose MTX (HD-MTX) to 42 (14%). After a median follow-up of 6.8 years, 36 of 585 patients relapsed in the CNS, of whom 14 had received prophylaxis. The CNS relapse risk at 1 year was lower for patients who received prophylaxis than patients who did not: 2% vs. 7.1%. However, the difference became less significant over time (5-year risk 5.6% vs. 7.5%), indicating prophylaxis tended to delay CNS relapse rather than prevent it. Furthermore, the CNS relapse risk was similar in patients who received IT and HD-MTX (5-year risk 5.6% vs. 5.2%). Collectively, our data indicate the benefit of MTX for CNS prophylaxis is transient, highlighting the need for more effective prophylactic regimens. In addition, our results failed to demonstrate a clinical advantage for the HD-MTX regimen. © 2021, The Author(s). |
| Journal Title: | Blood Cancer Journal |
| Volume: | 11 |
| Issue: | 6 |
| ISSN: | 2044-5385 |
| Publisher: | Nature Publishing Group |
| Date Published: | 2021-06-16 |
| Start Page: | 113 |
| Language: | English |
| DOI: | 10.1038/s41408-021-00506-3 |
| PUBMED: | 34135307 |
| PROVIDER: | scopus |
| PMCID: | PMC8209097 |
| DOI/URL: | |
| Notes: | Article -- Export Date: 1 July 2021 -- Source: Scopus |
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