Please use this identifier to cite or link to this item: https://doi.org/10.1038/s41408-021-00535-y
Title: High-dose methotrexate is effective for prevention of isolated CNS relapse in diffuse large B cell lymphoma
Authors: Ong, Shin Yeu 
de Mel, Sanjay
Grigoropoulos, Nicholas Francis 
Chen, Yunxin 
Tan, Yan Chin
Tan, Melinda Si Yun 
Ng, Lawrence Cheng Kiat 
Lee, Yuh Shan
Phipps, Colin
Goh, Yeow Tee 
Yong, Kar Ying
Liu, Xin
Chng, Wee Joo 
Lim, Soon Thye 
Nagarajan, Chandramouli 
Keywords: Science & Technology
Life Sciences & Biomedicine
Oncology
Hematology
NERVOUS-SYSTEM RELAPSE
AGGRESSIVE LYMPHOMA
PROPHYLAXIS
RISK
RITUXIMAB
RECURRENCE
SURVIVAL
DLBCL
CHOP
Issue Date: 12-Aug-2021
Publisher: SPRINGERNATURE
Citation: Ong, Shin Yeu, de Mel, Sanjay, Grigoropoulos, Nicholas Francis, Chen, Yunxin, Tan, Yan Chin, Tan, Melinda Si Yun, Ng, Lawrence Cheng Kiat, Lee, Yuh Shan, Phipps, Colin, Goh, Yeow Tee, Yong, Kar Ying, Liu, Xin, Chng, Wee Joo, Lim, Soon Thye, Nagarajan, Chandramouli (2021-08-12). High-dose methotrexate is effective for prevention of isolated CNS relapse in diffuse large B cell lymphoma. BLOOD CANCER JOURNAL 11 (8). ScholarBank@NUS Repository. https://doi.org/10.1038/s41408-021-00535-y
Abstract: The role of central nervous system (CNS) prophylaxis with high-dose methotrexate (HDMTX) in DLBCL is controversial. In this retrospective study, we evaluated the efficacy of prophylactic HDMTX on isolated CNS relapse, concomitant CNS and systemic relapse, systemic relapse, and survival outcomes in 226 patients with newly diagnosed DLBCL and high-risk CNS International Prognostic Index (CNS-IPI) score treated with RCHOP. The three-year risk of isolated CNS relapse was significantly lower in patients who received HDMTX, at 3.1% compared to 14.6% (P = 0.032) in those who did not. However, neither concomitant CNS-systemic relapse rates, systemic relapse rates, nor three-year PFS and OS were significantly different between treatment groups in multivariable analysis. Among propensity score-matched patients (N = 102), HDMTX was also associated with significantly lower isolated CNS relapse rates (HR 0.06, 95% CI 0.004–0.946, P = 0.046). HDMTX was well tolerated with manageable toxicities when given at a dose of 3 g/m2 by day 3 of RCHOP chemotherapy. Using propensity score matching and multivariable regression to yield treatment groups with well-balanced covariates, we showed that prophylactic HDMTX improved isolated CNS relapse rates but did not decrease concomitant CNS-systemic relapse rates, systemic relapse rates, or improve survival outcomes.
Source Title: BLOOD CANCER JOURNAL
URI: https://scholarbank.nus.edu.sg/handle/10635/207776
ISSN: 20445385
DOI: 10.1038/s41408-021-00535-y
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