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Timing of high-dose methotrexate CNS prophylaxis in DLBCL: a multicenter international analysis of 1384 patients.
Wilson, Matthew R; Eyre, Toby A; Kirkwood, Amy A; Wong Doo, Nicole; Soussain, Carole; Choquet, Sylvain; Martinez-Calle, Nicolás; Preston, Gavin; Ahearne, Matthew; Schorb, Elisabeth; Moles-Moreau, Marie-Pierre; Ku, Matthew; Rusconi, Chiara; Khwaja, Jahanzaib; Narkhede, Mayur; Lewis, Katharine L; Calimeri, Teresa; Durot, Eric; Renaud, Loïc; Øvlisen, Andreas Kiesbye; McIlroy, Graham; Ebsworth, Timothy J; Elliot, Johnathan; Santarsieri, Anna; Ricard, Laure; Shah, Nimish; Liu, Qin; Zayac, Adam S; 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; Strüßmann, Tim; Htut, Thura Win; Clavert, Aline; Scott, Hamish; Guidetti, Anna; Barlow, Brett R; Tchernonog, Emmanuelle; Smith, Jeffery; Miall, Fiona.
Afiliación
  • Wilson MR; Beatson West of Scotland Cancer Centre, Glasgow, United Kingdom.
  • Eyre TA; Oxford University Hospitals NHS Trust, Churchill Cancer Center, Oxford, United Kingdom.
  • Kirkwood AA; Cancer Research UK and UCL Cancer Trials Centre, UCL Cancer Institute, London, United Kingdom.
  • Wong Doo N; Concord Clinical School, Concord Hospital University of Sydney, Sydney, NSW, Australia.
  • Soussain C; Institut Curie Hôpital René Huguenin, Saint-Cloud, France.
  • Choquet S; La Pitie Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP)-Sorbonne Universite, Paris, France.
  • Martinez-Calle N; Nottingham University Hospitals NHS Trust, Nottingham, United Kingdom.
  • Preston G; Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
  • Ahearne M; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
  • Schorb E; Department of Medicine, University Medical Center Freiburg, Freiburg, Germany.
  • Moles-Moreau MP; Service des Maladies du Sang, CHU Angers, Angers, France.
  • Ku M; St Vincent's Private Hospital Melbourne, Melbourne, VIC, Australia.
  • Rusconi C; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  • Khwaja J; University College London Hospitals NHS Foundation Trust, London, United Kingdom.
  • Narkhede M; University of Alabama at Birmingham, Birmingham, AL.
  • Lewis KL; Linear Clinical Research and Sir Charles Gairdner Hospital, Perth, WA, Australia.
  • Calimeri T; IRCCS San Raffaele Scientific Institute, Milan, Italy.
  • Durot E; Hôpital Robert Debré CHU de Reims, Reims, France.
  • Renaud L; Hôpital Saint-Louis, AP-HP, Paris, France.
  • Øvlisen AK; Aalborg University Hospital, Aalborg, Denmark.
  • McIlroy G; University Hospitals Birmingham, Birmingham, United Kingdom.
  • Ebsworth TJ; University Hospital Southampton NHS Foundation Trust, Southampton, United Kingdom.
  • Elliot J; The Christie NHS Foundation Trust, Manchester, United Kingdom.
  • Santarsieri A; Cambridge University Hospitals NHS Foundation Trust, Cambridge, United Kingdom.
  • Ricard L; Hospital Saint-Antoine AP-HP, Paris, France.
  • Shah N; Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
  • Liu Q; Princess Margaret Cancer Centre, Toronto, ON, Canada.
  • Zayac AS; Brown University and Lifespan Cancer Institute, Providence, RI.
  • Vassallo F; Città della Salute e della Scienza di Torino, Torino, Italy.
  • Lebras L; Centre Léon Bérard, Lyon, France.
  • Roulin L; University Hospital Henri-Mondor AP-HP, Paris, France.
  • Lombion N; Hopital Mignot Centre Hospitalier de Versailles, Versailles, France.
  • Manos K; Austin Hospital, Melbourne, VIC, Australia.
  • Fernandez R; Hospital de Cabueñes, Gijon, Spain.
  • Hamad N; St Vincent's Hospital Sydney, Sydney, Australia.
  • Lopez-Garcia A; Fundacion Jimenez Diaz University Hospital, Health Research Institute Instituto de Investigaciòn Sanitaria-Fundacion Jimenex Diaz (IIS-FJD), Madrid, Spain.
  • O'Mahony D; Bon Secours Cork Cancer Centre, Cork, Ireland.
  • Gounder P; Concord Clinical School, Concord Hospital University of Sydney, Sydney, NSW, Australia.
  • Forgeard N; La Pitie Salpetriere Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP)-Sorbonne Universite, Paris, France.
  • Lees C; Oxford University Hospitals NHS Trust, Churchill Cancer Center, Oxford, United Kingdom.
  • Agbetiafa K; Institut Curie Hôpital René Huguenin, Saint-Cloud, France.
  • Strüßmann T; Department of Medicine, University Medical Center Freiburg, Freiburg, Germany.
  • Htut TW; Aberdeen Royal Infirmary, Aberdeen, United Kingdom.
  • Clavert A; Service des Maladies du Sang, CHU Angers, Angers, France.
  • Scott H; St Vincent's Private Hospital Melbourne, Melbourne, VIC, Australia.
  • Guidetti A; Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
  • Barlow BR; University of Alabama at Birmingham, Birmingham, AL.
  • Tchernonog E; CHU de Montpellier, Montpellier, France; and.
  • Smith J; Liverpool University Hospitals Foundation Trust, Liverpool, United Kingdom.
  • Miall F; University Hospitals of Leicester NHS Trust, Leicester, United Kingdom.
Blood ; 139(16): 2499-2511, 2022 04 21.
Article en En | MEDLINE | ID: mdl-34995350
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 1384 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 = .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 = 1253). In patients with a high CNS international prognostic index (n = 600), the 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 a reduction in CNS relapse. R-CHOP delays of ≥7 days were significantly increased with i-HD-MTX vs EOT, with 308 of 1573 (19.6%) i-HD-MTX treatments resulting in a 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 vs 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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Linfoma de Células B Grandes Difuso / Neoplasias del Sistema Nervioso Central Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: Blood Año: 2022 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Linfoma de Células B Grandes Difuso / Neoplasias del Sistema Nervioso Central Tipo de estudio: Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Humans Idioma: En Revista: Blood Año: 2022 Tipo del documento: Article País de afiliación: Reino Unido Pais de publicación: Estados Unidos