Patient Selection for High-Dose Methotrexate As Central Nervous System Prophylaxis in Diffuse Large B-Cell Lymphoma in Australia: Are We Getting It Right?

Abstract

Abstract Introduction: Diffuse large B cell lymphoma (DLBCL) is the most common lymphoid malignancy. While central nervous system (CNS) relapse in DLBCL is uncommon, it is usually fatal. As many relapses are parenchymal, systemic high-dose methotrexate (HDMTX) has largely replaced intrathecal methotrexate as CNS prophylaxis in high risk patients (historically characterised using IPI score/number of extranodal sites) in Australia. However, the efficacy of HDMTX in this context remains undetermined, can be associated with nephrotoxicity, myelosuppression and hepatotoxicity and necessitates the use of significant hospital resources for administration and monitoring. The German hi..