Please use this identifier to cite or link to this item: https://ahro.austin.org.au/austinjspui/handle/1/28544
Title: Timing of high dose methotrexate CNS prophylaxis in DLBCL: a multicenter international analysis of 1,384 patients.
Austin Authors: Wilson, Matthew R;Eyre, Toby Andrew;Kirkwood, Amy A;Wong Doo, Nicole;Soussain, Carole;Choquet, Sylvain;Martinez-Calle, Nicolás;Preston, Gavin;Ahearne, Matthew J;Schorb, Elisabeth;Moles-Moreau, Marie-Pierre;Ku, Matthew;Rusconi, Chiara;Khwaja, Jahanzaib;Narkhede, Mayur;Lewis, Katharine Louise;Calimeri, Teresa;Durot, Eric;Renaud, Loïc;Øvlisen, Andreas Kiesbye;Mcilroy, Graham;Ebsworth, Timothy John;Elliot, Johnathon;Santarsieri, Anna;Ricard, Laure;Shah, Nimish;Liu, Qin;Zayac, Adam Stephen;Vassallo, Francesco;Lebras, Laure;Roulin, Louise;Lombion, Naelle;Manos, Kate ;Fernandez, Ruben;Hamad, Nada;Lopez-Garcia, Alberto;O'Mahony, Deirdre;Gounder, Praveen;Forgeard, Nathalie;Lees, Charlotte;Agbetiafa, Kossi;Strüessmann, Tim;Htut, Thura Win;Clavert, Aline;Scott, Hamish;Guidetti, Anna;Barlow, Brett R;Tchernonog, Emmanuelle;Smith, Jeffery;Miall, Fiona;Fox, Christopher P;Cheah, Chan Y;El Galaly, Tarec Christoffer;Ferreri, Andrés J M;Cwynarski, Kate;McKay, Pamela
Affiliation: Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
St Vincent's Hospital, Darlinghurst, Australia
Austin Health
Sir Charles Gairdner Hospital, NEDLANDS, Australia
St Vincent's Hospital, Fitzroy, Australia
Concord Clinical School, Sydney, Australia
Sir Charles Gairdner Hospital, Perth, Australia
Oxford University Hospitals NHS Trust, Oxford, United Kingdom
UCL, London, United Kingdom..
Institut Curie, saint-cloud, France
Groupe Hospitalier Pitié Salpétrière, Paris, France
Nottingham University Hospitals, Nottingham, United Kingdom
Aberdeen Royal Infirmary, Aberdeen, United Kingdom
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Faculty of Medicine, University of Freiburg, Freiburg, Germany
chu angers, angers, France
Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
University College Hospital, London, UK, London, United Kingdom
University of Alabama at Birmingham, Birmingham, Alabama, United States
San Raffaele Scientific Institute, Milano, Italy
Hôpital Robert Debré CHU de Reims, Reims cedex, France
Hôpital Saint-Louis, Assistance Publique-Hôpitaux de Paris (AP-HP), Université Paris Diderot, Paris, France, Paris, France
Aalborg Universitetshospital, Aalborg, Denmark
University of Birmingham, Birmingham, United Kingdom
University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom
The Christie NHS Foundation Trust, Manchester, United Kingdom
Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom
Hôpital Saint Antoine, Paris, France
Norfolk and Norwich University Hospital, Norwich, United Kingdom
Princess Margaret Cancer Centre, Toronto, Ontario, Canada
Englewood Hospital and Medical Center, Englewood, New Jersey, United States
AOU Città della Salute e della Scienza di Torino, Torino, Italy
Centre Léon Bérard, lyon, France
University Hospital Henri-Mondor Assistance Publique-Hôpitaux de Paris, Creteil, France
Centre Hospitalier de Versailles, Versailles, France
Hospital de Cabueñes
Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Madrid, Spain
Bon Secours Cork Cancer Centre, Cork, Ireland
Groupe Hospitalier Pitié Salpétrière, Paris, France
Oxford University Hospitals NHS Trust, Oxford, United Kingdom
Institut Curie, saint-cloud, France
University of Freiburg Medical Center, Freiburg, Germany
Aberdeen Royal Infirmary, Aberdeen, United Kingdom
CHU, ANGERS, Florida, France
Fondazione IRCCS Istituto Nazionale Tumori, Milano, Italy
University of Alabama at Birmingham, Birmingham, Alabama, United States
CHU Montpellier
Liverpool University Hospitals Foundation Trust, Liverpool, UK, Liverpool, United Kingdom
University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
Nottingham University Hospitals, Nottingham, United Kingdom
Aalborg University Hospital, Aalborg, Denmark
San Raffaele Scientific Institute, Milan, Italy
UCLH, London, United Kingdom
Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom
Issue Date: 7-Jan-2022
Date: 2022-01-07
Publication information: Blood 2022; online first: 7 January
Abstract: Prophylactic high-dose methotrexate (HD-MTX) is often used for diffuse large B-cell lymphoma (DLBCL) patients at high risk of central nervous system (CNS) relapse, despite limited evidence demonstrating efficacy or the optimal delivery method. We conducted a retrospective, international analysis of 1,384 patients receiving HD-MTX CNS prophylaxis either intercalated (i-HD-MTX) (n=749) or at the end (n=635) of R-CHOP/R-CHOP-like therapy (EOT). There were 78 CNS relapses (3-year rate 5.7%), with no difference between i-HD-MTX and EOT; 5.7% vs 5.8%, p=0.98, 3-year difference: 0.04% (-2.0% to 3.1%). Conclusions were unchanged on adjusting for baseline prognostic factors or on 6-month landmark analysis (n=1,253). In patients with high CNS international prognostic index (n=600), 3-year CNS relapse rate was 9.1% with no difference between i-HD-MTX and EOT. On multivariable analysis, increasing age and renal/adrenal involvement were the only independent risk factors for CNS relapse. Concurrent intrathecal prophylaxis was not associated with reduction in CNS relapse. R-CHOP delays of ≥7 days were significantly increased with i-HD-MTX versus EOT, with 308/1573 (19.6%) i-HD-MTX treatments resulting in delay to subsequent R-CHOP (median 8 days). Increased risk of delay occurred in older patients when delivery was later than day 10 in the R-CHOP cycle. In summary, we found no evidence that EOT delivery increases CNS relapse risk versus i-HD-MTX. Findings in high-risk subgroups were unchanged. Rates of CNS relapse in this HD-MTX-treated cohort were similar to comparable cohorts receiving infrequent CNS prophylaxis. If HD-MTX is still considered for certain high-risk patients, delivery could be deferred until R-CHOP completion.
URI: https://ahro.austin.org.au/austinjspui/handle/1/28544
DOI: 10.1182/blood.2021014506
ORCID: 0000-0001-5423-3270
0000-0002-6631-9749
0000-0003-3725-3397
0000-0002-5184-9464
0000-0002-2037-3926
0000-0002-9289-1335
0000-0002-4993-7828
0000-0003-0549-5877
0000-0003-3463-0089
0000-0001-7213-9464
0000-0002-4449-2196
0000-0003-4416-3285
0000-0002-7591-2069
0000-0001-7929-1450
0000-0002-5354-5261
0000-0001-8725-4422
0000-0002-5508-1472
0000-0002-6322-9254
0000-0001-7988-1565
0000-0002-4406-380X
0000-0001-9606-6124
0000-0002-3959-9730
Journal: Blood
PubMed URL: 34995350
PubMed URL: https://pubmed.ncbi.nlm.nih.gov/34995350/
Type: Journal Article
Appears in Collections:Journal articles

Show full item record

Page view(s)

72
checked on May 17, 2024

Google ScholarTM

Check


Items in AHRO are protected by copyright, with all rights reserved, unless otherwise indicated.