Timing of high dose methotrexate CNS prophylaxis in DLBCL: a multicenter international analysis of 1,384 patients
dc.contributor.author | Wilson, M. R. | |
dc.contributor.author | Eyre, T. A. | |
dc.contributor.author | Kirkwood, A. A. | |
dc.contributor.author | Wong Doo, N. | |
dc.contributor.author | Soussain, C. | |
dc.contributor.author | Choquet, S. | |
dc.contributor.author | Martinez-Calle, N. | |
dc.contributor.author | Preston, G. | |
dc.contributor.author | Ahearne, M. J. | |
dc.contributor.author | Schorb, E. | |
dc.contributor.author | Moles-Moreau, M. P. | |
dc.contributor.author | Ku, M. | |
dc.contributor.author | Rusconi, C. | |
dc.contributor.author | Khwaja, J. | |
dc.contributor.author | Narkhede, M. | |
dc.contributor.author | Lewis, K. L. | |
dc.contributor.author | Calimeri, T. | |
dc.contributor.author | Durot, E. | |
dc.contributor.author | Renaud, L. | |
dc.contributor.author | Øvlisen, A. K. | |
dc.contributor.author | McIlroy, G. | |
dc.contributor.author | Ebsworth, T. J. | |
dc.contributor.author | Elliot, J. | |
dc.contributor.author | Santarsieri, A. | |
dc.contributor.author | Ricard, L. | |
dc.contributor.author | Shah, N. | |
dc.contributor.author | Liu, Q. | |
dc.contributor.author | Zayac, A. S. | |
dc.contributor.author | Vassallo, F. | |
dc.contributor.author | Lebras, L. | |
dc.contributor.author | Roulin, L. | |
dc.contributor.author | Lombion, N. | |
dc.contributor.author | Manos, K. | |
dc.contributor.author | Fernandez, R. | |
dc.contributor.author | Hamad, N. | |
dc.contributor.author | Lopez-Garcia, A. | |
dc.contributor.author | O'Mahony, D. | |
dc.contributor.author | Gounder, P. | |
dc.contributor.author | Forgeard, N. | |
dc.contributor.author | Lees, C. | |
dc.contributor.author | Agbetiafa, K. | |
dc.contributor.author | Strüessmann, T. | |
dc.contributor.author | Htut, T. W. | |
dc.contributor.author | Clavert, A. | |
dc.contributor.author | Scott, H. | |
dc.contributor.author | Guidetti, A. | |
dc.contributor.author | Barlow, B. R. | |
dc.contributor.author | Tchernonog, E. | |
dc.contributor.author | Smith, J. | |
dc.contributor.author | Miall, F. | |
dc.contributor.author | Fox, C. P. | |
dc.contributor.author | Cheah, C. Y. | |
dc.contributor.author | El Galaly, T. C. | |
dc.contributor.author | Ferreri, A. J. M. | |
dc.contributor.author | Cwynarski, K. | |
dc.contributor.author | McKay, P. | |
dc.date.accessioned | 2022-01-31T15:49:08Z | |
dc.date.available | 2022-01-31T15:49:08Z | |
dc.date.issued | 2022 | en |
dc.identifier.citation | Wilson MR, Eyre TA, Kirkwood AA, Wong Doo N, Soussain C, Choquet S, et al. Timing of high dose methotrexate CNS prophylaxis in DLBCL: a multicenter international analysis of 1,384 patients. Blood. 2022. | en |
dc.identifier.pmid | 34995350 | en |
dc.identifier.doi | 10.1182/blood.2021014506 | en |
dc.identifier.uri | http://hdl.handle.net/10541/625029 | |
dc.description.abstract | 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 1,384 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=0.98, 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=1,253). In patients with high CNS international prognostic index (n=600), 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 reduction in CNS relapse. R-CHOP delays of ≥7 days were significantly increased with i-HD-MTX versus EOT, with 308/1573 (19.6%) i-HD-MTX treatments resulting in 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 versus 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. | en |
dc.language.iso | en | en |
dc.relation.url | https://dx.doi.org/10.1182/blood.2021014506 | en |
dc.title | Timing of high dose methotrexate CNS prophylaxis in DLBCL: a multicenter international analysis of 1,384 patients | en |
dc.type | Article | en |
dc.contributor.department | Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom | en |
dc.identifier.journal | Blood | en |
dc.description.note | en] |