Incorporating High-Dose IV Methotrexate Into Initial Therapy Results In Lower Rates Of Central Nervous System (CNS) Relapse In Patients With High-Risk Diffuse Large B-Cell Lymphoma (DLBCL)

• Published in: Blood 2013-11, Vol.122 (21), p.4353-4353
• Main Authors: Cheah, Chan Y, Herbert, Kirsten, O'Rourke, Kacey, Kennedy, Glen, George, Anupkumar, Fedele, Pasquale, Tan, Shuh Ying, Opat, Stephen, Burbury, Kate, Wolf, Max, Januszewicz, Elchanan H., Dickinson, Michael J., Westerman, David A, Prince, H. Miles, Carney, Dennis A, Harrison, Simon J., Tam, Constantine S., Seymour, John F
• Format: Article
• Language: English
• ISSN: 0006-4971; 1528-0020
• DOI: 10.1182/blood.V122.21.4353.4353

▪ CNS relapse in DLBCL is a devastating complication and the optimum strategy for prevention remains unclear. We performed a multi-centre, retrospective analysis of CNS relapse rates in patients (pts) identified at risk of CNS relapse according to the type of CNS-directed prophylaxis administered. Pts receiving initial therapy for DLBCL between 1996 and 2011 (to allow ≥2 years of follow up) were included; DLBCL after histologic transformation of low-grade lymphoma and HIV-associated DLBCL were included, however pts with Burkitt or Burkitt-like lymphoma or CNS involvement at diagnosis were excluded. Selection for CNS prophylaxis strategy was by the primary managing hematologist if they fulfilled ≥2 of the following criteria: 1) multiple extranodal sites 2) raised serum LDH 3) B-symptoms, OR involvement of specific high-risk anatomical sites. We compared 3 prophylaxis strategies: prior to 2003 intrathecal (IT) methotrexate (MTX) in conjunction with CHOP chemotherapy “group 1” was the main strategy; from 2003 onwards, R-CHOP (mostly) with IT MTX was followed by two cycles of high dose intravenous (IV) MTX (1-3g/m2) “group 2”; patients