Methotrexate for Preventing CNS Relapse in Large B-Cell Lymphoma?

Parenchymal and leptomeningeal central nervous system (CNS) involvement is a feared complication of aggressive B-cell lymphomas. CNS-penetrating high-dose methotrexate (HD MTX) has long been used as prophylaxis; however, recent large retrospective analyses cast doubt on its efficacy. Now, an international consortium has retrospectively analyzed outcomes in 1923 patients with newly diagnosed large B-cell lymphoma (LBCL) deemed to be at ultra-high risk for CNS relapse (i.e., having renal/adrenal, testicular, or breast involvement; 3 or more extranodal sites; or a high CNS prognostic index score). Patients received multiagent anthracycline-based immunochemotherapy with or without HD MTX.