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International Journal of Hematology

, Volume 110, Issue 1, pp 86–94 | Cite as

Systemic HD-MTX for CNS prophylaxis in high-risk DLBCL patients: a prospectively collected, single-center cohort analysis

  • Kyoungmin Lee
  • Dok Hyun Yoon
  • Jung Yong Hong
  • Shin Kim
  • Kyoungmin Lee
  • Eun Hee Kang
  • Jooryung Huh
  • Chan-Sik Park
  • Sang Wook Lee
  • Cheolwon SuhEmail author
Original Article

Abstract

We evaluated the efficacy of systemic high-dose methotrexate (HD-MTX) for CNS prophylaxis in a prospectively recruited cohort of DLBCL patients at high risk of CNS relapse. High-risk CNS relapse was defined as the involvement of ≥ 2 extranodal sites with elevated lactate dehydrogenase (LDH); CNS international prognostic index (CNS-IPI) ≥ 4; or involvement of high-risk extranodal sites, including bone marrow, breasts, testes, and paranasal sinuses. Overall, 130 patients who received at least two cycles of standard chemoimmunotherapy were evaluated; of these, 64 patients received additional systemic HD-MTX, either on day 15 of alternating cycles or 2–5 weeks after completion of primary therapy. Patients receiving HD-MTX showed a generally higher risk of CNS relapse than the other 66 patients not receiving prophylaxis. The estimated 2-year cumulative CNS relapse, progression-free survival and overall survival rates were 8.1%, 66.3%, and 77.5%, respectively, in patients who received systemic HD-MTX and 6.9%, 67.4%, and 71.4%, respectively, in patients without prophylaxis, with no significant between-group differences. Although this study does not show that systemic HD-MTX is definitively effective, these results may be of help to other researchers investigating the utility of HD-MTX prophylaxis in mitigating negative risk factors.

Keywords

Diffuse large B-cell lymphoma CNS relapse CNS prophylaxis Systemic high dose methotrexate 

Notes

Acknowledgements

The authors thank the many patients and their families, as well as the physicians, who made this study possible.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Japanese Society of Hematology 2019

Authors and Affiliations

  • Kyoungmin Lee
    • 1
  • Dok Hyun Yoon
    • 1
  • Jung Yong Hong
    • 1
  • Shin Kim
    • 1
  • Kyoungmin Lee
    • 1
  • Eun Hee Kang
    • 1
  • Jooryung Huh
    • 2
  • Chan-Sik Park
    • 2
  • Sang Wook Lee
    • 3
  • Cheolwon Suh
    • 1
    Email author
  1. 1.Department of Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  2. 2.Department of Pathology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea
  3. 3.Department of Radiation Oncology, Asan Medical CenterUniversity of Ulsan College of MedicineSeoulRepublic of Korea

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