Intrathecal Methotrexate Reduces Recurrence in Non-Hodgkin's Lymphoma

Laurie Barclay, MD

August 01, 2002

Aug. 2, 2002 -- Prophylactic intrathecal methotrexate significantly reduced recurrence and improved survival for patients in complete remission from aggressive non-Hodgkin's lymphoma (NHL), according to a retrospective cohort analysis reported in the Aug. 1 issue of Cancer.

"Central nervous system (CNS) recurrence is almost invariably fatal in patients with aggressive NHL," write Naoto Tomita, MD, and colleagues from the Yokohama City University School of Medicine in Japan. "Although some protocols are intended to prevent CNS disease, the value of CNS prophylaxis in patients with aggressive NHL remains to be determined."

The investigators studied 68 adults with NHL in complete remission (CR) after systemic chemotherapy. Age range was 15 to 77 years (median, 56 years), and median follow-up after CR was 40 months. After attaining CR, 29 patients each received four doses of intrathecal methotrexate 10 mg/m2 and hydrocortisone 15 mg/m2, while 39 patients did not receive CNS prophylaxis.

Although more patients receiving CNS prophylaxis had bulky mass (45% vs. 21%; P=.03), none had CNS recurrence, compared with six patients (15%) who did not receive prophylaxis ( P=.03). Risk factors for CNS recurrence were no prophylaxis and bone marrow involvement. Five-year overall survival rate was 80% in the group that received intrathecal methotrexate and 58% in the group that did not ( P=.05). Corresponding rates for five-year recurrence-free survival were 85% and 51%, respectively ( P=.01).

"Prophylactic intrathecal methotrexate and hydrocortisone injection reduces the incidence of CNS recurrence following CR in patients with aggressive NHL and improves the chance of long-term survival," the authors write. "Further randomized controlled studies are warranted to define subgroups with particular survival benefit from CNS prophylaxis."

Cancer. 2002;95(3):576-580

Reviewed by Gary D. Vogin, MD

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