Details

Autor(en) / Beteiligte

• Wilson, Matthew R.
• Eyre, Toby A.
• Kirkwood, Amy A.
• Wong Doo, Nicole
• Soussain, Carole
• Choquet, Sylvain
• Martinez-Calle, Nicolás
• Preston, Gavin
• Ahearne, Matthew
• Schorb, Elisabeth
• Moles-Moreau, Marie-Pierre
• Ku, Matthew
• Rusconi, Chiara
• Khwaja, Jahanzaib
• Narkhede, Mayur
• Lewis, Katharine L.
• Calimeri, Teresa
• Durot, Eric
• Renaud, Loïc
• Øvlisen, Andreas Kiesbye
• McIlroy, Graham
• Ebsworth, Timothy J.
• Elliot, Johnathan
• Santarsieri, Anna
• Ricard, Laure
• Shah, Nimish
• Liu, Qin
• Zayac, Adam S.
• Vassallo, Francesco
• Lebras, Laure
• Roulin, Louise
• Lombion, Naelle
• Manos, Kate
• Fernandez, Ruben
• Hamad, Nada
• Lopez-Garcia, Alberto
• O'Mahony, Deirdre
• Gounder, Praveen
• Forgeard, Nathalie
• Lees, Charlotte
• Agbetiafa, Kossi
• Strüßmann, Tim
• Htut, Thura Win
• Clavert, Aline
• Scott, Hamish
• Guidetti, Anna
• Barlow, Brett R.
• Tchernonog, Emmanuelle
• Smith, Jeffery
• Miall, Fiona
• Fox, Christopher P.
• Cheah, Chan Y.
• El Galaly, Tarec Christoffer
• Ferreri, Andrés J.M.
• Cwynarski, Kate
• McKay, Pamela

Titel

Timing of high-dose methotrexate CNS prophylaxis in DLBCL: a multicenter international analysis of 1384 patients

Ist Teil von

• Blood, 2022-04, Vol.139 (16), p.2499-2511

Ort / Verlag

United States: Elsevier Inc

Erscheinungsjahr

2022

Quelle

MEDLINE

Beschreibungen/Notizen

• Prophylactic high-dose methotrexate (HD-MTX) is often used for diffuse large B-cell lymphoma (DLBCL) patients at high risk of central nervous system (CNS) relapse, despite limited evidence demonstrating efficacy or the optimal delivery method. We conducted a retrospective, international analysis of 1384 patients receiving HD-MTX CNS prophylaxis either intercalated (i-HD-MTX) (n = 749) or at the end (n = 635) of R-CHOP/R-CHOP-like therapy (EOT). There were 78 CNS relapses (3-year rate 5.7%), with no difference between i-HD-MTX and EOT: 5.7% vs 5.8%, P = .98; 3-year difference: 0.04% (−2.0% to 3.1%). Conclusions were unchanged on adjusting for baseline prognostic factors or on 6-month landmark analysis (n = 1253). In patients with a high CNS international prognostic index (n = 600), the 3-year CNS relapse rate was 9.1%, with no difference between i-HD-MTX and EOT. On multivariable analysis, increasing age and renal/adrenal involvement were the only independent risk factors for CNS relapse. Concurrent intrathecal prophylaxis was not associated with a reduction in CNS relapse. R-CHOP delays of ≥7 days were significantly increased with i-HD-MTX vs EOT, with 308 of 1573 (19.6%) i-HD-MTX treatments resulting in a delay to subsequent R-CHOP (median 8 days). Increased risk of delay occurred in older patients when delivery was later than day 10 in the R-CHOP cycle. In summary, we found no evidence that EOT delivery increases CNS relapse risk vs i-HD-MTX. Findings in high-risk subgroups were unchanged. Rates of CNS relapse in this HD-MTX-treated cohort were similar to comparable cohorts receiving infrequent CNS prophylaxis. If HD-MTX is still considered for certain high-risk patients, delivery could be deferred until R-CHOP completion. •End of treatment HD-MTX did not increase risk of CNS relapse compared with intercalated delivery and caused fewer delays to R-CHOP therapy.•CNS relapse rates in this large analysis of HD-MTX-treated patients were similar to published cohorts receiving minimal CNS prophylaxis. [Display omitted]