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Delayed Methotrexate Elimination Following High-dose Methotrexate Prophylaxis in High-risk Diffuse Large B-cell
Masahiro Akimoto1, Takuya Miyazaki1, Hiroyuki Takahashi2
1Department of Hematology, Yokohama City University Medical Center, Japan.
Internal Medicine (Tokyo, Japan)
|March 16, 2025
Summary
High-dose methotrexate (HD-MTX) for CNS prophylaxis in diffuse large B-cell lymphoma (DLBCL) can cause delayed elimination. Shorter infusion times, like 3 hours, may reduce this risk and associated toxicities.
Area of Science:
- Oncology
- Pharmacology
- Clinical Medicine
Background:
- High-dose methotrexate (HD-MTX) is standard for CNS prophylaxis in high-risk diffuse large B-cell lymphoma (DLBCL).
- Ensuring the safety and minimizing adverse events of HD-MTX prophylaxis is crucial.
- Limited data exists on the safety profile of HD-MTX in this specific patient population.
Purpose of the Study:
- To analyze adverse events associated with HD-MTX in high-risk DLBCL patients.
- To investigate the incidence and impact of delayed methotrexate elimination.
- To identify strategies for mitigating HD-MTX related complications.
Main Methods:
- Multicenter retrospective study of 98 DLBCL patients receiving HD-MTX for CNS prophylaxis (2014-2020).
- HD-MTX administered at 3.0 g/m² in 2 cycles, 2 weeks apart.
- Analysis focused on delayed MTX elimination and associated toxicities.
Main Results:
- Overall incidence of delayed MTX elimination was 18.4%.
- No delayed elimination occurred with a 3-hour MTX infusion (n=50).
- Delayed elimination correlated with higher toxicity rates (77.8% vs. 26.2%), including severe adverse events and renal dysfunction.
Conclusions:
- Delayed MTX elimination is linked to increased complications in DLBCL patients.
- Shorter MTX infusion durations, specifically 3 hours, may decrease the risk of delayed elimination.
- Optimizing infusion protocols can improve HD-MTX safety for CNS prophylaxis.
Keywords:
central nervous system prophylaxiscentral nervous system relapsedelayed MTX eliminationdiffuse large B-cell lymphomahigh-dose methotrexateMore Related Videos
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