Prophylaxis with intrathecal or high-dose methotrexate in diffuse large B-cell lymphoma and high risk of CNS relapse
Bobillo, Sabela (Universitat Autònoma de Barcelona. Departament de Medicina)
Joffe, Erel (Memorial Sloan Kettering Cancer Center (Estats Units d'Amèrica))
Sermer, David (Memorial Sloan Kettering Cancer Center (Estats Units d'Amèrica))
Mondello, Patrizia (Memorial Sloan Kettering Cancer Center (Estats Units d'Amèrica))
Ghione, Paola (Memorial Sloan Kettering Cancer Center (Estats Units d'Amèrica))
Caron, Philip C. (Memorial Sloan Kettering Cancer Center (Estats Units d'Amèrica))
Hamilton, Audrey (Memorial Sloan Kettering Cancer Center (Estats Units d'Amèrica))
Hamlin, Paul A. (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Horwitz, Steven M. (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Kumar, Anita (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Matasar, Matthew J. (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Batlevi, Connie L. (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Moskowitz, Alison (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Noy, Ariela (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Owens, Collette N. (Memorial Sloan Kettering Cancer Center (Estats Units d'Amèrica))
Palomba, M. Lia (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Straus, David (Weill Cornell Medical College. Weill Cornell Department of Medicine)
von Keudell, Gottfried (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Dogan, Ahmet (Memorial Sloan Kettering Cancer Center. Department of Pathology)
Zelenetz, Andrew D. (Weill Cornell Medical College. Weill Cornell Department of Medicine)
Seshan, Venkatraman E. (Memorial Sloan Kettering Cancer Center)
Younes, Anas (Weill Cornell Medical College. Weill Cornell Department of Medicine)

Data:	2021
Resum:	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.
Drets:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Llengua:	Anglès
Document:	Article ; recerca ; Versió publicada
Matèria:	B-cell lymphoma ; Disease-free survival
Publicat a:	Blood Cancer Journal, Vol. 11 (june 2021) , ISSN 2044-5385

DOI: 10.1038/s41408-021-00506-3
PMID: 34135307

6 p, 785.8 KB

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