Biological Findings and Clinical Outcomes in Patients Treated With R-CHOP Plus High-Dose Methotrexate as First-Line...

Area of Science:

• Oncology
• Hematology
• Lymphoma Research

Background:

• Primary testicular lymphoma (PTL) is a rare form of diffuse large B-cell lymphoma (DLBCL), comprising 1%-2% of all DLBCL cases.
• Both PTL and nodal DLBCL with testis involvement (DLBCL-T) are linked to poor prognoses and a high rate of central nervous system relapse.

Purpose of the Study:

• To evaluate the efficacy of high-dose methotrexate plus R-CHOP in patients with PTL and DLBCL-T.
• To compare treatment outcomes and relapse rates between PTL and DLBCL-T.

Main Methods:

• A cohort of 15 patients (5 with PTL, 10 with DLBCL-T) received high-dose methotrexate plus R-CHOP chemotherapy.
• Patient responses, including complete response (CR) and overall response rate (ORR), were assessed.
• Follow-up data were collected to determine remission duration and relapse rates, particularly for central nervous system relapse.

Main Results:

• An overall CR rate of 73% and an ORR of 86% were achieved in the study cohort.
• All patients (100%) with PTL achieved CR, with no relapses observed during a median follow-up of 3.9 years.
• In contrast, 55% of DLBCL-T patients achieved CR, but only one remained in remission at the end of follow-up.

Conclusions:

• High-dose methotrexate plus R-CHOP demonstrates high efficacy in PTL, leading to durable complete responses.
• DLBCL-T shows a less favorable outcome compared to PTL, with a higher relapse rate despite comparable treatment.
• Molecular similarities between PTL and Primary CNS Lymphoma (PCNSL) suggest shared biological pathways, warranting further investigation for targeted therapies.