Charles Gaulin, Associate Program Director of the Hematology and Medical Oncology Fellowship Program and Hematologic Oncologist at Dartmouth Hitchcock Medical Center, shared on LinkedIn:
“Is it time to officially retire high-dose methotrexate prophylaxis in large B-cell lymphoma?
For decades, we have used systemic HD-MTX to prevent secondary CSN relapse in high-risk patients.
But despite wide clinical adoption, it was never validated in prospective randomized trials-and new multi-center data strongly suggests it’s time to move on.
I spoke with Dr. Matthew R. Wilson who led a recently published study pooling data from 1932 ultra-high-risk patients across 56 global sites.
3-Year CNS Relapse Rate: 9.3% (No HD-MTX)vs. 8.1% (HD-MTX) – no statistically significant difference.
Isolated CNS Relapse Rate: 5.9% vs. 5.7% -virtually identical. High-Risk Subgroups (e.g., Testicular Involvement):
Even historically ‘mandatory’ subgroups showed no significant benefit in preventing isolated CNS events (6.1% vs. 6.3%).
What is your center’s current approach to CNS prophylaxis in DLBCL?
Are you ready to omit HD-MTX PPx in all patients?
Discussion on Blood Cancers Today.“
Title: High-Dose Methotrexate as CNS Prophylaxis in Ultra High-Risk Large B-Cell Lymphoma: An International Multicenter Analysis
Authors: Matthew R. Wilson, Katharine L. Lewis, Amy A. Kirkwood, Kate Cwynarski, Chan Y. Cheah, Tarec C. El-Galaly, Diego Villa, et al., Toby A. Eyre
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