Al-Sarayfi, Diana (2022) Impact of intrathecal methotrexate prophylaxis on central nervous system relapse: a population-based study among patients with diffuse large B-cell lymphoma in the Netherlands. thesis, Medicine.
Full text available on request.Abstract
Introduction: Central nervous system (CNS) relapse in patients with diffuse large B-cell lymphoma (DLBCL) is an uncommon event with dismal outcome. Until recently high-risk patients usually receive prophylactic methotrexate intrathecal (MTX IT) to minimize CNS relapse. However, data supporting the efficacy of MTX IT are scarce. Therefore, we aimed to assess the impact of MTX IT on relapse rate and survival in patients diagnosed with DLBCL at population level. Methods: DLBCL patients ≥18 years, diagnosed in 2014-2016, who received at least one cycle of immunochemotherapy, were identified in the Netherlands Cancer Registry. The primary endpoint was cumulative incidence (CIF), with CNS relapse as primary event of interest and death as competing event. Results: Of the 3,456 patients included in this study, 383 (11%) patients received MTX IT and 3,073 (89%) patients did not. Patients who received MTX were younger and had a higher Ann Arbor stage and CNS-IPI as compared to patients who did not receive MTX. With a median follow-up of 56 moths, the overall CIF for CNS relapse was 3%. The 4-years CNS CIF for patients with and without MTX IT were 4% and 3%, respectively (p=0.07). Regarding multivariable analyses, CNS CIF for patients treated with MTX IT was similar to patients treated without MTX IT after adjustment for CNS-IPI and number of treatment cycles. Conclusion: In the Dutch population of patients with DLBCL, no difference in proportions of CNS relapse was observed between patients with or without MTX IT. Additional analysis using propensity score matching is being done, to estimate the impact of MTX IT. in the Dutch population.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Nijland, Dr. M. and Brink, Dr. M. and Durmaz, Drs. M. |
| Faculty: | Medical Sciences |
| Date Deposited: | 05 May 2023 13:35 |
| Last Modified: | 05 May 2023 13:35 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3512 |
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