Please use this identifier to cite or link to this item: https://doi.org/10.1038/s41408-021-00535-y
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dc.titleHigh-dose methotrexate is effective for prevention of isolated CNS relapse in diffuse large B cell lymphoma
dc.contributor.authorOng, Shin Yeu
dc.contributor.authorde Mel, Sanjay
dc.contributor.authorGrigoropoulos, Nicholas Francis
dc.contributor.authorChen, Yunxin
dc.contributor.authorTan, Yan Chin
dc.contributor.authorTan, Melinda Si Yun
dc.contributor.authorNg, Lawrence Cheng Kiat
dc.contributor.authorLee, Yuh Shan
dc.contributor.authorPhipps, Colin
dc.contributor.authorGoh, Yeow Tee
dc.contributor.authorYong, Kar Ying
dc.contributor.authorLiu, Xin
dc.contributor.authorChng, Wee Joo
dc.contributor.authorLim, Soon Thye
dc.contributor.authorNagarajan, Chandramouli
dc.date.accessioned2021-11-24T04:16:13Z
dc.date.available2021-11-24T04:16:13Z
dc.date.issued2021-08-12
dc.identifier.citationOng, 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
dc.identifier.issn20445385
dc.identifier.urihttps://scholarbank.nus.edu.sg/handle/10635/207776
dc.description.abstractThe 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.
dc.language.isoen
dc.publisherSPRINGERNATURE
dc.sourceElements
dc.subjectScience & Technology
dc.subjectLife Sciences & Biomedicine
dc.subjectOncology
dc.subjectHematology
dc.subjectNERVOUS-SYSTEM RELAPSE
dc.subjectAGGRESSIVE LYMPHOMA
dc.subjectPROPHYLAXIS
dc.subjectRISK
dc.subjectRITUXIMAB
dc.subjectRECURRENCE
dc.subjectSURVIVAL
dc.subjectDLBCL
dc.subjectCHOP
dc.typeArticle
dc.date.updated2021-11-22T06:19:24Z
dc.contributor.departmentCANCER SCIENCE INSTITUTE OF SINGAPORE
dc.contributor.departmentDEAN'S OFFICE (DUKE-NUS MEDICAL SCHOOL)
dc.contributor.departmentDUKE-NUS MEDICAL SCHOOL
dc.contributor.departmentDUKE-NUS OFFICE OF ACAD & CLINICAL DEVT
dc.description.doi10.1038/s41408-021-00535-y
dc.description.sourcetitleBLOOD CANCER JOURNAL
dc.description.volume11
dc.description.issue8
dc.published.statePublished
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