title: Intrathecal methotrexate prophylaxis and central nervous system relapse in patients with diffuse large B-cell lymphoma following rituximab plus cyclophosphamide, doxorubicin, vincristine and prednisone.
abstract: This study evaluated the efficacy of central nervous system (CNS) prophylaxis using intrathecal methotrexate (IT-MTX) in patients with diffuse large B-cell lymphoma (DLBCL). We retrospectively studied 322 patients who achieved first complete remission (CR) after rituximab plus cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) therapy. The CNS prophylaxis consisted of four doses of IT-MTX (15 mg) with hydrocortisone (25 mg) administered after CR was achieved. Forty patients (12%) received CNS prophylaxis (group A) and 282 patients (88%) did not (group B). Three patients in group A (8%) and eight in group B (3%) experienced isolated CNS relapse during the first CR, although this difference was not statistically significant (p = 0.14). Ten of 11 CNS relapses occurred in the brain parenchyma with (n = 3) or without (n = 7) leptomeningeal involvement, and the remaining patient had exclusive leptomeningeal involvement. In patients with DLBCL attaining CR after R-CHOP, IT-MTX administration was insufficient to prevent CNS relapse.
authors.affiliation: Department of Internal Medicine and Clinical Immunology, Yokohama City University Graduate School of Medicine , Yokohama , Japan.
authors.forename: Naoto
authors.initials: N
authors.lastname: Tomita
authors.forename: Hirotaka
authors.initials: H
authors.lastname: Takasaki
authors.forename: Yasufumi
authors.initials: Y
authors.lastname: Ishiyama
authors.forename: Kumiko
authors.initials: K
authors.lastname: Kishimoto
authors.forename: Daisuke
authors.initials: D
authors.lastname: Ishibashi
authors.forename: Satoshi
authors.initials: S
authors.lastname: Koyama
authors.forename: Yoshimi
authors.initials: Y
authors.lastname: Ishii
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takahashi
authors.forename: Ayumi
authors.initials: A
authors.lastname: Numata
authors.forename: Reina
authors.initials: R
authors.lastname: Watanabe
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Tachibana
authors.forename: Rika
authors.initials: R
authors.lastname: Ohshima
authors.forename: Maki
authors.initials: M
authors.lastname: Hagihara
authors.forename: Chizuko
authors.initials: C
authors.lastname: Hashimoto
authors.forename: Sachiya
authors.initials: S
authors.lastname: Takemura
authors.forename: Jun
authors.initials: J
authors.lastname: Taguchi
authors.forename: Katsumichi
authors.initials: K
authors.lastname: Fujimaki
authors.forename: Rika
authors.initials: R
authors.lastname: Sakai
authors.forename: Shigeki
authors.initials: S
authors.lastname: Motomura
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Ishigatsubo
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000188:drug therapy*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D053208:Kaplan-Meier Estimate; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy*; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011241:Prednisone / Q000008:administration & dosage; D012074:Remission Induction; D012189:Retrospective Studies; D000069283:Rituximab / Q000008:administration & dosage; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage; D055815:Young Adult
chemical_list: D000069283:Rituximab; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone; D008727:Methotrexate
keywords: Central nervous system; R-CHOP; diffuse large B-cell lymphoma; intrathecal methotrexate