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A prospective cohort study of methotrexate plus idarubicin in newly diagnosed primary CNS lymphoma

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Abstract

Purpose

High-dose methotrexate (HD-MTX)-based chemotherapy regimen is the first-line option for primary central nervous system lymphoma (PCNSL). This prospective cohort study aimed to evaluate the efficacy and adverse effects of HD-MTX plus idarubicin (IDA) in patients with newly diagnosed immunocompetent PCNSL.

Methods

We recruited newly diagnosed PCNSL patients from January 2017 to August 2020. Patients were assigned into two groups: HD-MTX monotherapy and HD-MTX plus IDA (HD-MTX/IDA). In the HD-MTX monotherapy group, patients were treated with MTX 8 g/m2 alone on day 1, while the HD-MTX/IDA group received MTX 8 g/m2 on day 1 and IDA 10 mg/m2 on day 2. Treatments were repeated every 3 weeks for 8 cycles except for progression and/or unacceptable toxicity.

Results

We recruited 61 PCNSL patients, including 36 in the HD-MTX and 25 in the HD-MTX/IDA group. The CR rate was 68% in the HD-MTX/IDA group and 72.22% of patients in the HD-MTX monotherapy group (p = 0.7221), while the overall response rate was 72% vs. 77.78% (p = 0.6063). Median PFS in HD-MTX/IDA group and HD-MTX monotherapy group were 15.6 months and 18.5 months, respectively (p = 0.6374). Median OS was not reached in both groups. There were no significant differences in adverse effects between the two groups.

Conclusions

The combination of IDA with HD-MTX showed no obvious therapeutic advantage over HD-MTX monotherapy in newly diagnosed patients with PCNSL. HD-MTX dose of 8 g/m2 monotherapy can still provide better therapeutic benefits in patients with acceptable adverse effects. Future studies could explore HD-MTX in combination with other chemotherapeutic agents in the first-line treatment of PCNSL.

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Data availability

The datasets generated during and/or analyzed during the current study are available from the corresponding author on reasonable request.

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Acknowledgements

Not applicable.

Funding

Shanghai Shenkang Clinical Innovation Project (Project No. SHDC12020112). Beijing Medical and Health Foundation (Project No. YWJKJJHKB175B). Clinical Research Plan of SHDC (SHDC 2020CR6005-002).

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    Authors and Affiliations

    1. Department of Hematology, Huashan Hospital, Shanghai, China

      Qing Li, Yan Ma, Zhiguang Lin, Jingjing Ma, Hui Kang, Mengxue Zhang & Bobin Chen

    2. Institutes of Biomedical Sciences, Fudan University, Shanghai, China

      Huiwen Xu

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    1. Qing Li
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    2. Yan Ma
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    Contributions

    All authors contributed to the study’s conception and design. Data collection and data analysis were performed by QL and YM. The first draft of the manuscript was written by QL and BC, and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

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    Correspondence to Bobin Chen.

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    Qing Li and Yan Ma are contributed equally to this work.

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    Li, Q., Ma, Y., Lin, Z. et al. A prospective cohort study of methotrexate plus idarubicin in newly diagnosed primary CNS lymphoma. J Neurooncol 163, 39–46 (2023). https://doi.org/10.1007/s11060-022-04062-z

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    • DOI: https://doi.org/10.1007/s11060-022-04062-z

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