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- Title
High-dose methotrexate is effective for prevention of isolated CNS relapse in diffuse large B cell lymphoma.
- Authors
Ong, Shin Yeu; de Mel, Sanjay; Grigoropoulos, Nicholas Francis; Chen, Yunxin; Tan, Yan Chin; Tan, Melinda Si Yun; Ng, Lawrence Cheng Kiat; Lee, Yuh Shan; Phipps, Colin; Goh, Yeow Tee; Yong, Kar Ying; Liu, Xin; Chng, Wee Joo; Lim, Soon Thye; Nagarajan, Chandramouli
- Abstract
The role of central nervous system (CNS) prophylaxis with high-dose methotrexate (HDMTX) in DLBCL is controversial. In this retrospective study, we evaluated the efficacy of prophylactic HDMTX on isolated CNS relapse, concomitant CNS and systemic relapse, systemic relapse, and survival outcomes in 226 patients with newly diagnosed DLBCL and high-risk CNS International Prognostic Index (CNS-IPI) score treated with RCHOP. The three-year risk of isolated CNS relapse was significantly lower in patients who received HDMTX, at 3.1% compared to 14.6% (P = 0.032) in those who did not. However, neither concomitant CNS-systemic relapse rates, systemic relapse rates, nor three-year PFS and OS were significantly different between treatment groups in multivariable analysis. Among propensity score-matched patients (N = 102), HDMTX was also associated with significantly lower isolated CNS relapse rates (HR 0.06, 95% CI 0.004–0.946, P = 0.046). HDMTX was well tolerated with manageable toxicities when given at a dose of 3 g/m2 by day 3 of RCHOP chemotherapy. Using propensity score matching and multivariable regression to yield treatment groups with well-balanced covariates, we showed that prophylactic HDMTX improved isolated CNS relapse rates but did not decrease concomitant CNS-systemic relapse rates, systemic relapse rates, or improve survival outcomes.
- Subjects
METHOTREXATE; B cell lymphoma; CENTRAL nervous system; PREVENTIVE medicine; CANCER chemotherapy
- Publication
Blood Cancer Journal, 2021, Vol 11, Issue 8, p1
- ISSN
2044-5385
- Publication type
Article
- DOI
10.1038/s41408-021-00535-y