Intrathecal methotrexate prophylaxis and central nervous system relapse in patients with diffuse large B-cell lymphoma following rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone.
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| Abstract |
This study evaluated the efficacy of central nervous system (CNS) prophylaxis using intrathecal methotrexate (IT-MTX) in patients with diffuse large B-cell lymphoma (DLBCL). We retrospectively studied 322 patients who achieved first complete remission (CR) after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. The CNS prophylaxis consisted of four doses of IT-MTX (15 mg) with hydrocortisone (25 mg) administered after CR was achieved. Forty patients (12%) received CNS prophylaxis (group A) and 282 patients (88%) did not (group B). Three patients in group A (8%) and eight in group B (3%) experienced isolated CNS relapse during the first CR, although this difference was not statistically significant (p = 0.14). Ten of 11 CNS relapses occurred in the brain parenchyma with (n = 3) or without (n = 7) leptomeningeal involvement, and the remaining patient had exclusive leptomeningeal involvement. In patients with DLBCL attaining CR after R-CHOP, IT-MTX administration was insufficient to prevent CNS relapse.
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| Authors | Naoto Tomita, Hirotaka Takasaki, Yasufumi Ishiyama, Kumiko Kishimoto, Daisuke Ishibashi, Satoshi Koyama, Yoshimi Ishii, Hiroyuki Takahashi, Ayumi Numata, Reina Watanabe, Takayoshi Tachibana, Rika Ohshima, Maki Hagihara, Chizuko Hashimoto, Sachiya Takemura, Jun Taguchi, Katsumichi Fujimaki, Rika Sakai, Shigeki Motomura, Yoshiaki Ishigatsubo |
| Journal | Leukemia & lymphoma (Leuk Lymphoma) Vol. 56 Issue 3 Pg. 725-9 (Mar 2015) ISSN: 1029-2403 [Electronic] United States |
| PMID | 24913502 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't) |
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