Limited efficacy of high-dose methotrexate to prevent the central nervous system relapse in patients with IVLBCL

Abstract

To evaluate the efficacy of high-dose methotrexate (HD-MTX, ≥1 g/m²) for the prevention of central nervous system (CNS) recurrence in patients with intravascular large B-cell lymphoma (IVLBCL), we reviewed 51 patients with pathologically diagnosed untreated IVLBCL. In total, there were five cases of CNS relapse (9.8%), and the 12-month CNS relapse rate was 9.2%. No statistical difference in CNS relapse rate (p = 0.86) was observed between patients with and without HD-MTX (n = 20 and 31, respectively). Furthermore, the composite endpoint defined as either CNS and/or neurolymphomatosis relapse was not significant in terms of the administration of HD-MTX (p = 0.25). No significant predictor of CNS relapse was found. In conclusion, patients with IVLBCL are at high risk of CNS recurrence; however, HD-MTX administration may not be effective for CNS recurrence prophylaxis.

Key points

• The administration of HD-MTX for patients with untreated IVLBCL may not be effective for preventing CNS relapse.

Keywords:

• Intravascular large B-cell lymphoma
• high-dose methotrexate
• central nervous system
• recurrence

Acknowledgments

The authors are very grateful to Dr Kengo Takeuchi (Division of Pathology, The Cancer Institute, Japanese Foundation for Cancer Research, Tokyo, Japan) for pathological diagnosis, and Dr Yasuhito Suehara (Department of Hematology, University of Tsukuba Hospital, Tsukuba, Japan) and Dr Akinao Okamoto (Department of Hematology, Fujita Health University School of Medicine, Japan) for digital droplet polymerase chain reaction.

Ethics approval

All study procedures involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the institutional review board.

Author contributions

Toshiki T. planned and designed the study, collected data, performed statistical analyses, wrote the manuscript, and provided patient care. Takafumi T., D. I., A. F., Y. K., A. K., R. T., D. M., K. N., and M. T. provided patient care. K. N. advised the statistical methods. K. M. initiated the study, collected data, provided patient care, wrote the manuscript, and supervised the study. All authors reviewed and approved the manuscript.

Disclosure statement

The authors have no conflicts of interest to declare that are relevant to the content of this article.

Data availability statement

The datasets generated during and/or analyzed during the current study are available from the corresponding author upon reasonable request.