Al-Mansour Mubarak, Absi Ahmed, Al-Μufti Roula, Alahmadi Majed, El-Ηemaidi Ihab, Alamoudi Sameer, Eldadah Saleem, Aga Syed Sameer, Khan Muhammed A, Alsaeed Ahmed
Department of Adult Medical Oncology, Princess Noorah Oncology Center, King Abdulaziz Medical City, Ministry of National Guard Health Affairs-Western Region, Jeddah 21423, Saudi Arabia.
College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Ministry of National Guard Health Affairs-Western Region, Jeddah 21423, Saudi Arabia.
Mol Clin Oncol. 2022 Oct 13;17(6):159. doi: 10.3892/mco.2022.2592. eCollection 2022 Dec.
Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) is rare (2-5% of cases), but is a devastating complication with a poor survival rate. The administration of high-dose methotrexate (HDMTX) for CNS prophylaxis in patients with DLBCL is controversial and variable in the literature. The present study aimed to evaluate the clinical outcomes of HDMTX CNS prophylaxis in patients with intermediate and high CNS-International Prognostic Index (IPI) DLBCL using real-world data. An observational retrospective cohort study was conducted of all patients with intermediate and high CNS-IPI DLBCL treated at Princess Noorah Oncology Center (King Abdulaziz Medical City, Jeddah, Saudi Arabia) between January 2010 and December 2020. Patients were treated with HDMTX either intravenously or intrathecally, according to the physician's evaluation of the patient. Data on patient clinical characteristics, CNS relapses, risk factors and survival rates were obtained from hospital records. Data were analyzed using Student's unpaired t-test and the χ test to compare the two subgroups, the Kaplan-Meier survival method with log-rank test to calculate and compare the survival rates, and regression analysis to determine the risk factors for CNS relapse and death. The study included 358 patients (n=32 with HDMTX CNS prophylaxis and n=326 without CNS prophylaxis). Patients in the CNS prophylaxis group had a significantly higher CNS relapse rate than those in the non-CNS prophylaxis group (12.5% vs. 1.8%; P=0.008). Patients who received CNS prophylaxis were younger and had an advanced stage of disease, with extranodal involvement and a high serum lactate dehydrogenase level at presentation. CNS prophylaxis was significantly associated with CNS relapse, while relapsed disease was associated with the risk of death (all P<0.05). In conclusion, the present study found that patients with intermediate and high CNS-IPI who received HDMTX CNS prophylaxis did not have fewer CNS relapses; however, those without CNS relapse had higher survival rates. In addition to CNS prophylaxis, Stage of DLBCL and IPI were significantly associated with CNS relapse. Future randomized control trials are needed to evaluate the efficacy of HDMTX CNS prophylaxis in patients with DLBCL.
弥漫性大B细胞淋巴瘤（DLBCL）患者的中枢神经系统（CNS）复发较为罕见（占病例的2%-5%），但却是一种具有毁灭性的并发症，生存率很低。对于DLBCL患者，采用大剂量甲氨蝶呤（HDMTX）进行CNS预防在文献中的应用存在争议且各不相同。本研究旨在利用真实世界数据评估HDMTX对中高危CNS-国际预后指数（IPI）的DLBCL患者进行CNS预防的临床效果。对2010年1月至2020年12月期间在诺拉公主肿瘤中心（沙特阿拉伯吉达阿卜杜勒阿齐兹国王医疗城）接受治疗的所有中高危CNS-IPI的DLBCL患者进行了一项观察性回顾性队列研究。根据医生对患者的评估，患者接受静脉或鞘内注射HDMTX治疗。从医院记录中获取患者临床特征、CNS复发、危险因素和生存率的数据。使用学生非配对t检验和χ检验分析数据以比较两个亚组，采用Kaplan-Meier生存法和对数秩检验计算和比较生存率，并进行回归分析以确定CNS复发和死亡的危险因素。该研究纳入了358例患者（32例接受HDMTX CNS预防，326例未接受CNS预防）。CNS预防组患者的CNS复发率显著高于非CNS预防组（12.5%对1.8%；P=0.008）。接受CNS预防的患者更年轻，疾病分期更晚，就诊时伴有结外受累和血清乳酸脱氢酶水平升高。CNS预防与CNS复发显著相关，而复发疾病与死亡风险相关（所有P<0.05）。总之，本研究发现，接受HDMTX CNS预防的中高危CNS-IPI患者的CNS复发并未减少；然而，未发生CNS复发的患者生存率更高。除了CNS预防外，DLBCL的分期和IPI与CNS复发显著相关。未来需要进行随机对照试验来评估HDMTX对DLBCL患者进行CNS预防的疗效。
