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

IF 3.1 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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高危弥漫性大b细胞淋巴瘤患者的中枢神经系统预防方法：回顾性单中心队列分析

最近在预防弥漫大b细胞淋巴瘤（DLBCL）方面的进展主要集中在预防其在中枢神经系统（CNS）患者复发的最佳策略上。本回顾性研究旨在评估静脉注射高剂量甲氨蝶呤（HD-MTX）方案对新诊断的具有中枢神经系统复发高风险的DLBCL患者的保护作用。方法新诊断的高危DLBCL患者136例(HD-MTX组：n = 46；非hd - mtx组：n = 90)纳入本回顾性研究。主要终点包括中枢神经系统复发率、无进展生存期（PFS）、总生存期（OS）和毒性。结果2年中枢神经系统复发率(中位随访时间：25.5个月；95%可信区间：21.0 ~ 30.0)，HD-MTX组和非HD-MTX组分别为4.3%和11.1% （p = 0.337）。此外，2年无进展生存期（PFS）和总生存期（OS）分别为70.7%对60.8%和72.9%对60.8% （p = 0.013和p = 0.024）。PFS和OS的亚组分析显示，被国家综合癌症网络(NCCN) -国际预后指数（IPI）分类为低或中危、年龄较小且无B症状的患者显示出HD-MTX治疗的潜在益处。总共有46例患者完成了92个周期的HD-MTX治疗，其中49个周期在R-CHOP方案的第6天进行，平均延迟不超过4天。相比之下，其余43个周期在R-CHOP方案完成后的10-14天开始，平均延迟15天。有趣的是，血液学或非血液学毒性的发生率在两组之间没有显著差异。结论由于缺乏强有力的证据，HD-MTX在预防中枢神经系统复发中的作用尚不能确定。然而，一些患者可以耐受这种治疗，如年轻人和NCCN-IPI低或中等风险的患者，这表明在第6天静脉注射HD-MTX是预防DLBCL中枢神经系统复发的最佳策略。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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.