December 8, 2025Blood

Safety and feasibility of high dose methotrexate addition to R-CHOP chemotherapy for prophylaxis and treatment of secondary cns involvement by large B-cell lymphoma in a community-based hospital setting

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Discussion

Retrospective study shows improved outcomes in CNS involvement in large B-cell lymphoma, suggesting earlier HDMTX may reduce relapses.

Addition of high dose methotrexate to R-CHOP demonstrated improved overall survival at 71.6% in patients with CNS involvement.
In a cohort of 36 patients, the notable outcomes included a CNS response rate of 71.4% in those receiving HDMTX.
Retrospective analysis of MR-CHOP treatment included HDMTX early in cycles to target CNS complications effectively.
Nephrotoxicity was observed in 16.6% of cases, emphasizing the balance of efficacy and safety in CNS prophylaxis.

Sagheer et al. (2025) studied this question.

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