Comparison of standardized prophylactic high-dose and intrathecal methotrexate for DLBCL with a high risk of CNS relapse

• Published in: International journal of hematology Vol. 119; no. 2; pp. 164 - 172
• Main Authors: Akimoto, Masahiro, Miyazaki, Takuya, Takahashi, Hiroyuki, Saigusa, Yusuke, Takeda, Takaaki, Hibino, Yuto, Tokunaga, Mayumi, Ohashi, Takuma, Matsumura, Ayako, Teshigawara, Haruka, Suzuki, Taisei, Teranaka, Hiroshi, Nakajima, Yuki, Matsumoto, Kenji, Hashimoto, Chizuko, Fujimaki, Katsumichi, Fujita, Hiroyuki, Sakai, Rika, Fujisawa, Shin, Nakajima, Hideaki
• Format: Journal Article
• Language: English
• Published: Singapore Springer Nature Singapore 01.02.2024; Springer Nature B.V
• Subjects: B-cell lymphoma; Central nervous system; Chemotherapy; Creatinine; Disease prevention; Drug dosages; Hematology; Hospitals; Immunomodulators; Lymphocytes B; Lymphoma; Medical prognosis; Medicine; Medicine & Public Health; Methotrexate; Nervous system; Oncology; Original Article; Patients; Prophylaxis; Risk; High-dose methotrexate; Central nervous system prophylaxis; Intrathecal methotrexate; Central nervous system relapse; Diffuse large B-cell lymphoma
• ISSN: 0925-5710; 1865-3774; 1865-3774
• DOI: 10.1007/s12185-023-03700-0

The efficacy of high-dose methotrexate (HD-MTX) for central nervous system (CNS) relapse prophylaxis in patients with high-risk diffuse large B-cell lymphoma (DLBCL) is controversial. We compared the prophylactic effects of HD-MTX and intrathecal methotrexate (IT-MTX) on CNS relapse in high-risk DLBCL, in a multicenter retrospective study. A total of 132 patients with DLBCL at high risk of CNS relapse who received frontline chemotherapy and IT-MTX from 2003 to 2013 ( n  = 34) or HD-MTX from 2014 to 2020 ( n  = 98) were included. After a median follow-up of 52 months (range: 9–174), 11 patients had isolated CNS relapse: six (6.1%) in the HD-MTX group and five (14.7%) in the IT-MTX group. The median time until CNS relapse was 38 months (range: 11–122), and the cumulative incidence of CNS relapse at 3 years was 3.9% in the HD-MTX group and 6.1% in the IT-MTX group ( P  = 0.93). Similar results were obtained after adjusting for background factors using propensity score-matched analysis (4.5% HD-MTX vs. 7.6% IT-MTX, P  = 0.84). The CNS relapse rate in HD-MTX-treated patients was equivalent to that in IT-MTX patients, demonstrating that HD-MTX was not superior to IT-MTX in preventing CNS relapse.