Summary of recent studies evaluating use of HD-MTX in DLBCL
| Study (year) . | n . | Design . | Risk factors . | Systemic treatment . | CNS Prophylaxis . | CNS relapse . | Comments . |
|---|---|---|---|---|---|---|---|
| Lewis et al32 (2022) | 2300 | Multicenter, retrospective | CNS-IPI ≥4 Testicular, breast involvement DHL | R-CHOP (94%) R-EPOCH (6%) | 1. HD-MTX (18%) 2. No HD-MTX (82%) | 1. 9.2% (5 y) 2. 8.1% (5 y) | No benefit HD-MTX |
| Wilson et al33 (2022) | 1384 | Multicenter, retrospective | High-risk EN sites CNS-IPI ≥4 ≥2 EN and LDH ↑ | R-CHOP | 1. HD-MTX (all, intercalated, or EOT) | 1. 5.7% (3 y) 2. 5.8% (3 y) | No difference between EOT and intercalated HD-MTX |
| Orellana-Noia et al34 (2022) | 1030 | Multicenter, retrospective | Not described | R-CHOP (48%) R-EPOCH (45%) Other (7%) | 1. HD-MTX (20%) 2. IT (77%) | 1. 6.8% 2. 5.4% | No benefit HD-MTX vs IT |
| Puckrin et al35 (2021) | 326 | Multicenter, retrospective | CNS-IPI ≥4 Testicular DHL LDH ↑ + ECOG >1 + >1 EN | R-CHOP (85%) Intensive chemotherapy (15%) | 1. HD-MTX (35%) 2. No HD-MTX (65%) | 1. 12.2% 2. 11.2% | No benefit HD-MTX |
| Bobillo et al36 (2021) | 585 | Single-center, retrospective | CNS-IPI ≥4 High-risk EN sites DHL | R-CHOP (68%) R-EPOCH (15%) Other (17%) | 1. HD-MTX (7%) 2. IT MTX (43%) 3. None (50%) | 1. 7.5% (5 y) 2. 5.5% (3 y) 3. 5% | No benefit (IT or HD-MTX) |
| Ong et al37 (2021) | 226 | Multicenter, retrospective | High-risk EN sites CNS-IPI ≥4 | R-CHOP | 1. HD-MTX (29%) 2. No HD-MTX (71%) | 1. 3.1% (3 y, isolated) 2. 14.6% (3 y, isolated) | HD-MTX significantly reduced risk of isolated CNS relapse |
| Wilson et al38 (2020) | 334 | Multicenter, retrospective | CNS-IPI ≥4 High-risk EN sites ≥2 EN sites and LDH ↑ | R-CHOP | 1. HD-MTX (all, intercalated, or EOT) | 1. 6.8% (3 y) 2. 4.7% (3 y) | No difference between EOT and intercalated HD-MTX |
| Lee et al39 (2019) | 130 | Single-center, retrospective | CNS-IPI ≥4 High-risk EN sites ≥2 EN and LDH ↑ | R-CHOP | 1. HD-MTX (49%) 2. None (51%) | 1. 6.9% (2 y) 2. 8.1% (2 y) | No benefit HD-MTX |
| Goldschmidt et al40 (2019) | 480 | Multicenter, retrospective | High-risk EN sites Stage IV, LDH ↑, ≥1 EN | CHOP +/−R (80%) | 1. HD-MTX (27%) 2. None (73%) | 1. 6.9% 2. 6.3% | No benefit HD-MTX |
| Study (year) . | n . | Design . | Risk factors . | Systemic treatment . | CNS Prophylaxis . | CNS relapse . | Comments . |
|---|---|---|---|---|---|---|---|
| Lewis et al32 (2022) | 2300 | Multicenter, retrospective | CNS-IPI ≥4 Testicular, breast involvement DHL | R-CHOP (94%) R-EPOCH (6%) | 1. HD-MTX (18%) 2. No HD-MTX (82%) | 1. 9.2% (5 y) 2. 8.1% (5 y) | No benefit HD-MTX |
| Wilson et al33 (2022) | 1384 | Multicenter, retrospective | High-risk EN sites CNS-IPI ≥4 ≥2 EN and LDH ↑ | R-CHOP | 1. HD-MTX (all, intercalated, or EOT) | 1. 5.7% (3 y) 2. 5.8% (3 y) | No difference between EOT and intercalated HD-MTX |
| Orellana-Noia et al34 (2022) | 1030 | Multicenter, retrospective | Not described | R-CHOP (48%) R-EPOCH (45%) Other (7%) | 1. HD-MTX (20%) 2. IT (77%) | 1. 6.8% 2. 5.4% | No benefit HD-MTX vs IT |
| Puckrin et al35 (2021) | 326 | Multicenter, retrospective | CNS-IPI ≥4 Testicular DHL LDH ↑ + ECOG >1 + >1 EN | R-CHOP (85%) Intensive chemotherapy (15%) | 1. HD-MTX (35%) 2. No HD-MTX (65%) | 1. 12.2% 2. 11.2% | No benefit HD-MTX |
| Bobillo et al36 (2021) | 585 | Single-center, retrospective | CNS-IPI ≥4 High-risk EN sites DHL | R-CHOP (68%) R-EPOCH (15%) Other (17%) | 1. HD-MTX (7%) 2. IT MTX (43%) 3. None (50%) | 1. 7.5% (5 y) 2. 5.5% (3 y) 3. 5% | No benefit (IT or HD-MTX) |
| Ong et al37 (2021) | 226 | Multicenter, retrospective | High-risk EN sites CNS-IPI ≥4 | R-CHOP | 1. HD-MTX (29%) 2. No HD-MTX (71%) | 1. 3.1% (3 y, isolated) 2. 14.6% (3 y, isolated) | HD-MTX significantly reduced risk of isolated CNS relapse |
| Wilson et al38 (2020) | 334 | Multicenter, retrospective | CNS-IPI ≥4 High-risk EN sites ≥2 EN sites and LDH ↑ | R-CHOP | 1. HD-MTX (all, intercalated, or EOT) | 1. 6.8% (3 y) 2. 4.7% (3 y) | No difference between EOT and intercalated HD-MTX |
| Lee et al39 (2019) | 130 | Single-center, retrospective | CNS-IPI ≥4 High-risk EN sites ≥2 EN and LDH ↑ | R-CHOP | 1. HD-MTX (49%) 2. None (51%) | 1. 6.9% (2 y) 2. 8.1% (2 y) | No benefit HD-MTX |
| Goldschmidt et al40 (2019) | 480 | Multicenter, retrospective | High-risk EN sites Stage IV, LDH ↑, ≥1 EN | CHOP +/−R (80%) | 1. HD-MTX (27%) 2. None (73%) | 1. 6.9% 2. 6.3% | No benefit HD-MTX |