ABSTRACT
The efficacy of high-dose methotrexate (HD-MTX) for central nervous system (CNS) relapse prophylaxis in patients with high-risk diffuse large B-cell lymphoma (DLBCL) is controversial. We compared the prophylactic effects of HD-MTX and intrathecal methotrexate (IT-MTX) on CNS relapse in high-risk DLBCL, in a multicenter retrospective study. A total of 132 patients with DLBCL at high risk of CNS relapse who received frontline chemotherapy and IT-MTX from 2003 to 2013 (n = 34) or HD-MTX from 2014 to 2020 (n = 98) were included. After a median follow-up of 52 months (range: 9-174), 11 patients had isolated CNS relapse: six (6.1%) in the HD-MTX group and five (14.7%) in the IT-MTX group. The median time until CNS relapse was 38 months (range: 11-122), and the cumulative incidence of CNS relapse at 3 years was 3.9% in the HD-MTX group and 6.1% in the IT-MTX group (P = 0.93). Similar results were obtained after adjusting for background factors using propensity score-matched analysis (4.5% HD-MTX vs. 7.6% IT-MTX, P = 0.84). The CNS relapse rate in HD-MTX-treated patients was equivalent to that in IT-MTX patients, demonstrating that HD-MTX was not superior to IT-MTX in preventing CNS relapse.
Subject(s)
Central Nervous System Neoplasms , Lymphoma, Large B-Cell, Diffuse , Humans , Methotrexate , Central Nervous System Neoplasms/drug therapy , Central Nervous System Neoplasms/prevention & control , Retrospective Studies , Neoplasm Recurrence, Local/prevention & control , Neoplasm Recurrence, Local/drug therapy , Lymphoma, Large B-Cell, Diffuse/drug therapy , Lymphoma, Large B-Cell, Diffuse/pathology , Chronic Disease , Antineoplastic Combined Chemotherapy Protocols/adverse effectsABSTRACT
The prognosis for relapsed adult T-cell leukemia/lymphoma (ATL) after allogeneic hematopoietic stem cell transplantation is poor. Here, we report the case of a 67-year-old man who survived for 26 months after treatment with lenalidomide for post-transplant relapsed ATL. He underwent induction therapy with two cycles of modified VCAP-AMP-VECP and achieved complete remission. He received cord blood cell transplantation following a reduced-intensity conditioning regimen. Seven months after transplantation, swelling of the systemic lymph nodes appeared, and relapsed ATL was diagnosed based on a biopsy of the cervical lymph node. Treatment with 10 mg of lenalidomide induced partial remission. At 18 months after transplantation, skin tumors were successfully treated by increasing the dose of lenalidomide to 15 mg with the emergence of skin graft-versus-host disease. Although he died from ATL at 34 months after transplantation, systemic relapsed lesions were controlled by treatment with lenalidomide for 26 months. Our case suggests that lenalidomide is well tolerated and is an effective option for the treatment of post-transplant relapsed ATL.
