Comparison of Standardized Prophylactic High-dose and Intrathecal Methotrexate for DLBCL with a High Risk of CNS Relapse

Overview

Journal Int J Hematol

Specialty Hematology

Date 2024 Jan 17

PMID 38233702

Authors

Masahiro Akimoto

Takuya Miyazaki

Hiroyuki Takahashi

Yusuke Saigusa

Takaaki Takeda

Yuto Hibino

Mayumi Tokunaga

Takuma Ohashi

Ayako Matsumura

Haruka Teshigawara

Taisei Suzuki

Hiroshi Teranaka

Yuki Nakajima

Kenji Matsumoto

Chizuko Hashimoto

Katsumichi Fujimaki

Hiroyuki Fujita

Rika Sakai

Shin Fujisawa

Hideaki Nakajima

Affiliations

Soon will be listed here.

Abstract

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.

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