Blood Cancer J: High-dose methotrexate can effectively prevent isolated CNS recurrence in DLBCL patients

1-14% of patients with diffuse large B-cell lymphoma (DLBCL) will have a central nervous system (CNS) recurrence.
Such patients have a poor prognosis, with a survival period of only 2-5 months
.

In view of concerns thatthe effectiveness ofintrathecal (IT) prevention may not reach a detectable concentration in the brain parenchyma, some guidelines recommend that patients with a high risk of CNS recurrence should be treated with systemic high-dose methotrexate (HDMTX) prophylaxis

1-14% of patients with diffuse large B-cell lymphoma (DLBCL) will have a central nervous system (CNS) recurrence.

This is a retrospective study in which researchers evaluated the effects of preventive HDMTX on isolated CNS recurrence, CNS and systemic co-recurrence, systemic recurrence, and survival prognosis
.

A total of 226 newly diagnosed DLBCL patients were enrolled, all of whom received RCHOP treatment and had a high-risk CNS International Prognostic Index (CNS-IPI) score

Cumulative recurrence rate of solitary CNS

Cumulative recurrence rate of solitary CNS

Compared with patients who did not receive prophylactic HDMTX, patients who received prophylactic HDMTX had a significantly lower 3-year risk of isolated CNS recurrence (3.
1% vs 14.
6%, p=0.
032)
.

However, in the multivariate analysis, there were no significant differences in CNS-systemic recurrence, systemic recurrence, 3-year progression-free survival (PFS) and overall survival (OS) between the two groups

Compared with patients who did not receive prophylactic HDMTX, patients who received prophylactic HDMTX had a significantly lower 3-year solitary CNS recurrence risk.

PFS and OS of the total test population

PFS and OS of the total test population

Among patients with matching propensity scores (n=102), HDMTX was also significantly associated with a lower rate of solitary CNS recurrence (HR 0.
06, 95% CI 0.
004–0.
946, p=0.
046)
.

On the third day of RCHOP chemotherapy, HDMTX was well tolerated and the toxicity was controllable when the dose was 3 g/m2

In patients with propensity score matching (n=102), HDMTX was also significantly associated with a lower rate of solitary CNS recurrence.

Preventive HDMTX can reduce the recurrence rate of isolated CNS.

Original source:

Ong, SY, de Mel, S.

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