Cancer Management and Research (Aug 2021)
Improvement of outcomes of an escalated high‐dose methotrexate-based regimen for patients with newly diagnosed primary central nervous system lymphoma: a real-world cohort study
Abstract
Qing Li,1,2,* Jingjing Ma,1,2,* Yan Ma,1,2 Zhiguang Lin,1,2 Hui Kang,1,2 Bobin Chen1,2 1Department of Hematology, Huashan Hospital North, Fudan University, Shanghai, 201907, People’s Republic of China; 2Department of Hematology, Huashan Hospital, Fudan University, Shanghai, 200040, People’s Republic of China*These authors contributed equally to this workCorrespondence: Bobin ChenDepartment of Hematology, 108 Luxiang Road, Baoshan District, Shanghai, People’s Republic of ChinaTel +86 21-52889999Email [email protected]: High‐dose methotrexate (HD‐MTX)-based chemotherapy regimen is the first-line treatment of primary central nervous system lymphoma (PCNSL). At present, doses of MTX in the range of 3.5– 8 g/m2 are frequently used. However, the optimal dose of methotrexate for PCNSL remains controversial. The purpose of this real-world study was to compare the efficacy and toxicity of HD-MTX in patients with untreated PCNSL.Methods: Immunocompetent adults with newly diagnosed PCNSL between January 2015 and December 2018 were investigated and followed up to June 2019. All patients’ initial treatments were based on HD‐MTX chemotherapy regimens.Results: A total of 73 patients were reviewed. For patients who received HD-MTX at 8 g/m2 vs.3.5 g/m2, the complete response (CR) rates were 68.29% vs 43.75% (p = 0.03), and the median PFS times were 17.7 months vs 9.05 months (HR=0.455, 95% CI 0.239– 0.865, p=0.016). There was no significant difference in OS between the two groups. Serious adverse effects were uncommon and clinically manageable.Conclusion: There is a correlation of treatment response and clinical outcomes between the dosage of MTX in initial induction therapy in newly diagnosed PCNSL. MTX dose of 8 g/m2 provided a higher CR rate and PFS benefits with acceptable adverse effects.Keywords: primary central nervous system lymphoma, high-dose methotrexate, chemotherapy, prognosis
