Addition of high-dose methotrexate to standard treatment for patients with high-risk diffuse large B-cell lymphoma contributes to improved freedom from progression and survival but does not prevent central nervous system relapse

Neta Goldschmidt*, Netanel A. Horowitz, Vered Heffes, Fares Darawshy, Tatiana Mashiach, Adir Shaulov, Moshe E. Gatt, Eldad J. Dann

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Combination of rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) is regarded as standard care for diffuse large B-cell lymphoma (DLBCL) and upfront intensification of therapy is still controversial. The current study aimed to dertermine whether the addition of high-dose methotrexate (HDMTX) affects long-term outcomes and could also prevent central nervous system (CNS) relapse. Medical records of 480 patients with DLBCL treated between 1994 and 2013 at Rambam and Hadassah medical centers in Israel were reviewed; 130 (27%) had received HDMTX. Patients receiving HDMTX generally had higher International Prognostic Index (IPI) and CNS-IPI scores. HDMTX addition significantly improved progression free and overall survival (p =.001) and this advantage was maintained in multivariate analysis (HR for OS 0.3; 95% CI 0.19–0.47; p <.0001). Thirty-one (6.5%) patients had CNS relapse and in these cases high CNS-IPI, but not HDMTX treatment, was independently associated with CNS relapse (HR 1.2; 95% CI 1.2–11.5; p =.02). In conclusion, the addition of HDMTX to CHOP/RCHOP independently and significantly improved prognosis of patients with high-risk DLBCL, irrespective of their risk for CNS relapse.

Original languageAmerican English
Pages (from-to)1890-1898
Number of pages9
JournalLeukemia and Lymphoma
Volume60
Issue number8
DOIs
StatePublished - 3 Jul 2019

Bibliographical note

Publisher Copyright:
© 2019, © 2019 Informa UK Limited, trading as Taylor & Francis Group.

Keywords

  • CNS relapse
  • Diffuse large B-cell lymphoma
  • high-dose methotrexate
  • survival

Fingerprint

Dive into the research topics of 'Addition of high-dose methotrexate to standard treatment for patients with high-risk diffuse large B-cell lymphoma contributes to improved freedom from progression and survival but does not prevent central nervous system relapse'. Together they form a unique fingerprint.

Cite this