Central Nervous System Prophylaxis Approach in High-Risk Diffuse Large B-Cell Lymphoma Patients: A Retrospectively Collected, Single-Center Cohort Analysis

IF 2.9 2区医学 Q2 ONCOLOGY

Cancer Medicine Pub Date : 2025-04-01 DOI:10.1002/cam4.70830

Yanli Wang, Xiaolian Wen, Tao Guan, Hongwei Zhang, Wei'e Han, Min Bai, Xiaolan Liu, Min Zhang, Liping Su, Weihua Zhang

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Abstract

Objectives

Recent advances in the prevention of diffuse large B-cell lymphoma (DLBCL) have considerably focused on optimal strategies for preventing its recurrence in the central nervous system (CNS) in patients. This retrospective study aimed to assess the protective efficacy of intravenous high-dose methotrexate (HD-MTX) regimens in newly diagnosed patients with DLBCL presenting a high risk for CNS recurrence.

Methods

A total of 136 newly diagnosed high-risk DLBCL patients (HD-MTX group: n = 46; non-HD-MTX group: n = 90) were enrolled in this retrospective study. The primary endpoints included CNS recurrence rate, progression-free survival (PFS), overall survival (OS), and toxicity.

Results

The 2-year CNS recurrence rates (median follow-up period: 25.5 months; 95% confidence interval: 21.0–30.0) were 4.3% and 11.1% in the HD-MTX and non-HD-MTX groups (p = 0.337), respectively. Additionally, the 2-year progression-free survival (PFS) and overall survival (OS) rates were 70.7% versus 60.8% and 72.9% versus 60.8% (p = 0.013 and p = 0.024), respectively. The subgroup analysis for PFS and OS revealed that patients classified as the National Comprehensive Cancer Network (NCCN)—International Prognostic Index (IPI) low- or intermediate-risk, at a younger age, and without B symptoms demonstrated potential benefits from the HD-MTX treatment. In total, 46 patients completed 92 cycles of HD-MTX treatment, of which, 49 cycles were administered on day 6 of the R-CHOP regimen, with an average delay of no more than 4 days. In contrast, the remaining 43 cycles were initiated on days 10–14 following the completion of the R-CHOP regimen, with an average delay of 15 days. Interestingly, the incidence of hematological or non-hematological toxicity did not differ significantly among the groups.

Conclusion

Owing to the lack of robust evidence, the role of HD-MTX in preventing CNS recurrence could not be conclusively determined. Nevertheless, some patients could tolerate the treatment, such as younger individuals and those at NCCN-IPI low or intermediate risk, suggesting the efficacy of intravenous HD-MTX administration on day 6 as an optimal strategy for preventing CNS recurrence of DLBCL.

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来源期刊

Cancer Medicine ONCOLOGY-

CiteScore

5.50

自引率

2.50%

发文量

907

审稿时长

19 weeks

期刊介绍： Cancer Medicine is a peer-reviewed, open access, interdisciplinary journal providing rapid publication of research from global biomedical researchers across the cancer sciences. The journal will consider submissions from all oncologic specialties, including, but not limited to, the following areas: Clinical Cancer Research Translational research ∙ clinical trials ∙ chemotherapy ∙ radiation therapy ∙ surgical therapy ∙ clinical observations ∙ clinical guidelines ∙ genetic consultation ∙ ethical considerations Cancer Biology: Molecular biology ∙ cellular biology ∙ molecular genetics ∙ genomics ∙ immunology ∙ epigenetics ∙ metabolic studies ∙ proteomics ∙ cytopathology ∙ carcinogenesis ∙ drug discovery and delivery. Cancer Prevention: Behavioral science ∙ psychosocial studies ∙ screening ∙ nutrition ∙ epidemiology and prevention ∙ community outreach. Bioinformatics: Gene expressions profiles ∙ gene regulation networks ∙ genome bioinformatics ∙ pathwayanalysis ∙ prognostic biomarkers. Cancer Medicine publishes original research articles, systematic reviews, meta-analyses, and research methods papers, along with invited editorials and commentaries. Original research papers must report well-conducted research with conclusions supported by the data presented in the paper.