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Study Clarifies Superiority of High-Dose Methotrexate at EOI for High-Risk Patients With DLBCL
A multicenter analysis has clarified the superiority of high-dose methotrexate at the end of induction (EOI) for high-risk patients with diffuse large B-cell lymphoma (DLBCL).
“Central nervous system (CNS) relapse of DLBCL is a rare but devastating event,” explained Yu Fang, BMBS, Department of Medical Oncology, Sun Yat-Sen University Cancer Center, Guangzhou, China, and co-authors.
Intravenous high-dose methotrexate is the recommended CNS prophylaxis, but the optimal timing and dose has not been determined, researchers said.
The study included 284 patients with DLBCL who received high-dose methotrexate either concurrent with each induction chemotherapy cycle (n = 221) or at the EOI therapy (n = 63). Patients with CNS-IPI scoring 4-6 and/or testicular involvement, and/or double/triple hit lymphoma, were stratified into a high-risk group, and the rest into a moderate-risk group.
An increased risk of grade 3-4 treatment-related toxicity (OR 1.49, P = .006) and subsequent chemotherapy delays (OR 1.87, P = .003) were associated with concurrent high-dose methotrexate.
At a median follow-up of 36 months, there were minimal differences seen in the rate of CNS relapse between the concurrent and EOI groups (3.2% vs 4.8%, P = .34), as well as the high-risk group.
Researchers suggested that high-dose methotrexate (≥ 2 g/m2) is associated with better CNS relapse control, but only for the high-risk group.
“This study may elucidate the superiority of EOI high-dose methotrexate to some extent. High methotrexate dose (≥ 2 g/m2) may not be necessary for the moderate-risk patients,” concluded Dr Fang et al.—Emily Bader
