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Key Points
• In the current retrospective study, researchers assessed the safety and efficacy of prophylactic high-dose methotrexate (HD-MTX) with regard to CNS relapse in 258 recently diagnosed high-risk DLBCL patients receiving R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone). This analysis was based on the initial treatment intent (ITT) of the physician to employ HD-MTX, with 128 patients in the ITT HD-MTX group and 130 in the non-ITT HD-MTX group.
• The CNS relapse rate was not significantly different between the two groups, with 2-year rates of 12.4% in the ITT group and 13.9% in the non-ITT group. Furthermore, there were no significant differences in the time-to-CNS relapse, progression-free survival, and overall survival, with the ITT group exhibiting higher rates of grade ≥ 3 oral mucositis and elevated alanine aminotransferase
• According to the authors, “HD-MTX prophylaxis was not associated with reduced CNS relapse rates or improved survival outcomes, and it was accompanied by increased toxicities in DLBCL patients at high risk for CNS relapse.”
• Limitations of the current study included selection bias due to its retrospective nature. Additionally, unmeasured clinical factors might not have been compensated for. Another limitation could be the small number of CNS relapse events that resulted in a less powerful analysis.
 

Efficacy and safety of prophylactic high-dose MTX in high-risk DLBCL: a treatment intent-based analysis - PubMed

Efficacy and safety of prophylactic high-dose MTX in high-risk DLBCL: a treatment intent-based analysis - PubMed

Source :

https://pubmed.ncbi.nlm.nih.gov/33881464/

Despite central nervous system (CNS) relapse occurring in >10% of high-risk diffuse large B-cell lymphoma (DLBCL) patients, the role of CNS-directed prophylaxis is controversial in the absence of randomized controlled trials. In this retrospective study, we aimed to evaluate the safety and effica ...

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    This is consistent with other recent studies presented at ash 2020 of the lack of benefit at reducing secondary cns lymphoma with hdmtx prophylaxis. In spite of this, my guess is that it will continue to be used in practice