High-Dose Methotrexate Is Not Associated with Reduction in CNS Relapse in Patients with Aggressive B-Cell Lymphoma: An International Retrospective Study of 2300 High-Risk Patients

作者：Katharine L. Lewis, Lasse Jakobsen, Diego Villa, Sabela Bobillo, Karin Ekstroem Smedby, Kerry J. Savage, Toby A. Eyre, Kate Cwynarski, Paris L. Caporn, Joan Van Zyl, Magdalena Klánová, Marek Trněný, Robert Puckrin, Douglas A. Stewart, Mark Bishton, Christopher P. Fox, Aung M. Tun, Gita Thanarajasingam, Faouzi Djebbari, Erel Joffe, Sandra Eloranta, Sara Harrysson, Laurie H. Sehn, Seth Maliske, Kittika Poonsombudlert, Xiao Guo, Greg Hapgood, Kate Manos, Eliza A. Hawkes, Jahanzaib Khwaja, Adrian Minson, Michael Dickinson, Andreas Kiesbye Øvlisen, Gareth P. Gregory, Michael Gilbertson, Isaac T Streit, Hamish W Scott, Matthew Ku, Sanjay De Mel, Kar Ying Yong, Xin Liu, Mridula Mokoonlall, Dipti Talaulikar, Nicholas L. McVilly, Anna Johnston, Matthew Brunner, Priyanka A. Pophali, Matthew J. Maurer, Tarec Christoffer El‐Galaly, Chan Y. Cheah · 发表于：Blood · 年份：2021 · DOI：10.1182/blood-2021-146737 · 被引用次数：19 · 研究领域：CNS Lymphoma Diagnosis and Treatment、Lymphoma Diagnosis and Treatment

Abstract Introduction Central nervous system relapse (secondary central nervous system lymphoma -SCNS) is an uncommon but devastating complication of aggressive B-cell lymphoma. Patients (Pts) with CNS-IPI 4-6 are at greatest risk (10.2% at 2 years). Intravenous high-dose methotrexate (HD-MTX) is widely used to mitigate SCNS risk but data supporting this practice are limited. Methods We performed a multicentre, retrospective study at 21 sites in Australia, Asia, North America and Europe. Chart or registry review was performed for consecutively diagnosed pts with diffuse large B-cell lymphoma (DLBCL) and CNS-IPI 4-6, high grade B-cell lymphoma (HGBL) with rearrangements of MYC+BCL2 and/or BCL6 and primary breast/testicular DLBCL irrespective of CNS-IPI. Pts were diagnosed between 2000-2020, 18-80 years at diagnosis, and treated with curative intent anti-CD20 based chemo-immunotherapy. Pts with CNS involvement at diagnosis were excluded. HD-MTX was defined as at least one cycle of intravenous MTX at any dose. Time to SCNS was calculated from date of diagnosis (all-pts), and from the end of frontline systemic lymphoma therapy, defined as 6x21 days from diagnosis (complete response (CR-pts)), until SCNS, systemic relapse, death, or censoring, whichever came first. Cumulative risk of SCNS was computed using the Aalen-Johansen estimator treating death and systemic relapses as competing events. Adjusted cumulative risks were obtained by using an inverse probability of treatment weig...