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dc.contributor.authorWilson, M. R.
dc.contributor.authorEyre, T. A.
dc.contributor.authorKirkwood, A. A.
dc.contributor.authorWong Doo, N.
dc.contributor.authorSoussain, C.
dc.contributor.authorChoquet, S.
dc.contributor.authorMartinez-Calle, N.
dc.contributor.authorPreston, G.
dc.contributor.authorAhearne, M. J.
dc.contributor.authorSchorb, E.
dc.contributor.authorMoles-Moreau, M. P.
dc.contributor.authorKu, M.
dc.contributor.authorRusconi, C.
dc.contributor.authorKhwaja, J.
dc.contributor.authorNarkhede, M.
dc.contributor.authorLewis, K. L.
dc.contributor.authorCalimeri, T.
dc.contributor.authorDurot, E.
dc.contributor.authorRenaud, L.
dc.contributor.authorØvlisen, A. K.
dc.contributor.authorMcIlroy, G.
dc.contributor.authorEbsworth, T. J.
dc.contributor.authorElliot, J.
dc.contributor.authorSantarsieri, A.
dc.contributor.authorRicard, L.
dc.contributor.authorShah, N.
dc.contributor.authorLiu, Q.
dc.contributor.authorZayac, A. S.
dc.contributor.authorVassallo, F.
dc.contributor.authorLebras, L.
dc.contributor.authorRoulin, L.
dc.contributor.authorLombion, N.
dc.contributor.authorManos, K.
dc.contributor.authorFernandez, R.
dc.contributor.authorHamad, N.
dc.contributor.authorLopez-Garcia, A.
dc.contributor.authorO'Mahony, D.
dc.contributor.authorGounder, P.
dc.contributor.authorForgeard, N.
dc.contributor.authorLees, C.
dc.contributor.authorAgbetiafa, K.
dc.contributor.authorStrüessmann, T.
dc.contributor.authorHtut, T. W.
dc.contributor.authorClavert, A.
dc.contributor.authorScott, H.
dc.contributor.authorGuidetti, A.
dc.contributor.authorBarlow, B. R.
dc.contributor.authorTchernonog, E.
dc.contributor.authorSmith, J.
dc.contributor.authorMiall, F.
dc.contributor.authorFox, C. P.
dc.contributor.authorCheah, C. Y.
dc.contributor.authorEl Galaly, T. C.
dc.contributor.authorFerreri, A. J. M.
dc.contributor.authorCwynarski, K.
dc.contributor.authorMcKay, P.
dc.date.accessioned2022-01-31T15:49:08Z
dc.date.available2022-01-31T15:49:08Z
dc.date.issued2022en
dc.identifier.citationWilson 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.pmid34995350en
dc.identifier.doi10.1182/blood.2021014506en
dc.identifier.urihttp://hdl.handle.net/10541/625029
dc.description.abstractProphylactic 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.isoenen
dc.relation.urlhttps://dx.doi.org/10.1182/blood.2021014506en
dc.titleTiming of high dose methotrexate CNS prophylaxis in DLBCL: a multicenter international analysis of 1,384 patientsen
dc.typeArticleen
dc.contributor.departmentBeatson West of Scotland Cancer Centre, Glasgow, United Kingdomen
dc.identifier.journalBlooden
dc.description.noteen]


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