Impact of High-Dose Methotrexate on the Outcome of Patients with Diffuse Large B-Cell Lymphoma and Skeletal Involvement

Autor:	Jonathan Farhi, Jérôme Paillassa, Aurelien Giltat, Emmanuel Gyan, Mathilde Hunault-Berger, Tony Marchand, Mélanie Mercier, Marie-Christine Rousselet, Roch Houot, Aline Clavert, Christopher Nunes Gomes, Laurianne Drieu La Rochelle, Marie-Pierre Moles-Moreau, Corentin Orvain
Jazyk:	angličtina
Rok vydání:	2021
Předmět:	Cancer Research medicine.medical_specialty Anthracycline medicine.medical_treatment lymphoma Gastroenterology bone Article 03 medical and health sciences 0302 clinical medicine Autologous stem-cell transplantation immune system diseases Internal medicine hemic and lymphatic diseases medicine high-dose methotrexate RC254-282 business.industry Neoplasms. Tumors. Oncology. Including cancer and carcinogens medicine.disease skeletal Lymphoma Radiation therapy Regimen Oncology 030220 oncology & carcinogenesis Methotrexate Rituximab business Diffuse large B-cell lymphoma 030215 immunology medicine.drug
Zdroj:	Cancers Volume 13 Issue 12 Cancers, Vol 13, Iss 2945, p 2945 (2021)
ISSN:	2072-6694
DOI:	10.3390/cancers13122945
Popis:	Diffuse large B-cell lymphoma (DLBCL) with extra nodal skeletal involvement is rare. It is currently unclear whether these lymphomas should be treated in the same manner as those without skeletal involvement. We retrospectively analyzed the impact of combining high-dose methotrexate (HD-MTX) with an anthracycline-based regimen and rituximab as first-line treatment in a cohort of 93 patients with DLBCL and skeletal involvement with long follow-up. Fifty patients (54%) received upfront HD-MTX for prophylaxis of CNS recurrence (high IPI score and/or epidural involvement) or because of skeletal involvement. After adjusting for age, ECOG, high LDH levels, and type of skeletal involvement, HD-MTX was associated with an improved PFS and OS (HR: 0.2, 95% CI: 0.1–0.3, p < 0.001 and HR: 0.1, 95% CI: 0.04–0.3, p < 0.001, respectively). Patients who received HD-MTX had significantly better 5-year PFS and OS (77% vs. 39%, p < 0.001 and 83 vs. 58%, p < 0.001). Radiotherapy was associated with an improved 5-year PFS (74 vs. 48%, p = 0.02), whereas 5-year OS was not significantly different (79% vs. 66%, p = 0.09). A landmark analysis showed that autologous stem cell transplantation was not associated with improved PFS or OS. The combination of high-dose methotrexate and an anthracycline-based immunochemotherapy is associated with an improved outcome in patients with DLBCL and skeletal involvement and should be confirmed in prospective trials.
Databáze:	OpenAIRE
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