ArticleBlood cancer journal2021
Prophylaxis with intrathecal or high-dose methotrexate in diffuse large B-cell lymphoma and high risk of CNS relapse.
Article in Blood cancer journal, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 41 papers, 1 of them a synthesis that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
41 citing papers in PubMed, 1 synthesis or guideline pooled it, 64 citations in OpenAlex.
- Pooled it
- The Efficacy and Toxicity of CNS Prophylaxis in Diffuse Large B-Cell Lymphoma (CLSG-CNS-01): A Randomized, Multicenter, Prospective Phase 3 Trial.Hematological oncology · 2026Trial
- Central nervous system relapse in younger patients with diffuse large B-cell lymphoma: a LYSA and GLA/DSHNHL analysis.Blood advances · 2023Trial
- Article
- Central nervous system recurrence of diffuse large B-cell lymphoma - risk stratification and prophylaxis.Hematology, transfusion and cell therapy · 2026Review
- Article
- Clinical Impact of BTK Inhibitor Exposure in LymphGen-Defined MCD Diffuse Large B-Cell Lymphoma.Hematological oncology · 2026Article
- Bilateral primary diffuse large B-cell lymphoma of the breast: diagnostic and surgical management-a case report.Gland surgery · 2026Article
- Clinical, Biological, and Treatment-Related Predictors of Central Nervous System Relapse in Diffuse Large B-Cell Lymphoma: A Retrospective Cohort Study.Journal of clinical medicine · 2026Article
- Protocol digest of a randomized phase III study of pola-R-CHP/high-dose methotrexate/IT vs. pola-R-CHP/IT for newly diagnosed diffuse large B-cell lymphoma with high risk of central nervous system relapse: JCOG2201 (PREMIER).Japanese journal of clinical oncology · 2026Article
- CNS prophylaxis with high-dose methotrexate and intrathecal chemotherapy improves survival in DLBCL with high CNS relapse risk.International journal of hematology · 2026Article
- Translating advances in primary central nervous system lymphoma: from prognostic stratification to treatment innovation.Frontiers in oncology · 2026Review
- Defining and Addressing the Current Unmet Medical Needs for the Frontline Treatment of Advanced Stage Aggressive Large B-Cell Lymphoma: A Perspective From an Ad Hoc Panel of Italian Experts.Hematological oncology · 2025Review
- Delayed Methotrexate Elimination Following High-dose Methotrexate Prophylaxis in High-risk Diffuse Large B-cell Lymphoma.Internal medicine (Tokyo, Japan) · 2025Article
- Risk of central nervous system versus systemic relapse in patients with diffuse large B-cell lymphoma treated with R-CHOP: What should we focus on?HemaSphere · 2025Article
- Experience of Using a Bruton Tyrosine Kinase (BTK) Inhibitor in Primary Testicular Diffuse Large B-Cell Lymphoma (DLBCL) with Isolated Central Nervous System (CNS) Metastasis.Journal of clinical practice and research · 2025Article
- Central Nervous System Prophylaxis Approach in High-Risk Diffuse Large B-Cell Lymphoma Patients: A Retrospectively Collected, Single-Center Cohort Analysis.Cancer medicine · 2025Article
- Treatments and Outcomes of Newly Diagnosed CD5-Positive Diffuse Large B-Cell Lymphoma: A Multi-Institutional Observational Study.Hematological oncology · 2025Observational
- Incidence and characterization of secondary CNS lymphoma in 1972 patients with DLBCL: a Danish nationwide cohort study.Blood advances · 2025Article
- Article
Corrections and comments
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Authors and funding
22 authors at 2 institutions in 2 countries.
Funding
Abstract
Although methotrexate (MTX) is the most widely used therapy for central nervous system (CNS) prophylaxis in patients with diffuse large B-cell lymphoma (DLBCL), the optimal regimen remains unclear. We examined the efficacy of different prophylactic regimens in 585 patients with newly diagnosed DLBCL and high-risk for CNS relapse, treated with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) or R-CHOP-like regimens from 2001 to 2017, of whom 295 (50%) received prophylaxis. Intrathecal (IT) MTX was given to 253 (86%) and high-dose MTX (HD-MTX) to 42 (14%). After a median follow-up of 6.8 years, 36 of 585 patients relapsed in the CNS, of whom 14 had received prophylaxis. The CNS relapse risk at 1 year was lower for patients who received prophylaxis than patients who did not: 2% vs. 7.1%. However, the difference became less significant over time (5-year risk 5.6% vs. 7.5%), indicating prophylaxis tended to delay CNS relapse rather than prevent it. Furthermore, the CNS relapse risk was similar in patients who received IT and HD-MTX (5-year risk 5.6% vs. 5.2%). Collectively, our data indicate the benefit of MTX for CNS prophylaxis is transient, highlighting the need for more effective prophylactic regimens. In addition, our results failed to demonstrate a clinical advantage for the HD-MTX regimen.
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