Evaluating high-dose methotrexate plus chemotherapy for patients with diffuse large B-cell lymphoma

This study evaluated the outcomes of treatment with high-dose methotrexate (Trexall) plus chemotherapy for diffuse B-cell lymphoma (DLBCL). This study concluded that this regimen was promising, with manageable side effects for these patients.

DLBCL is the most common type of non-Hodgkin’s lymphoma. Initial treatment is effective for many patients. However, about 30 – 40% of patients experience relapse (cancer recurrence) or develop refractory (does not respond to treatment) disease after first-line treatment. New treatment options are needed for these patients.

High-dose methotrexate is commonly used to treat DLBCL that has spread to the brain and spinal cord. Some patients with DLBCL may have the cancer come back and grow in these areas. Whether adding methotrexate to chemotherapy can improve outcomes for patients with DLBCL is unclear.

This study had 47 patients with newly diagnosed DLBCL. Patients received high-dose methotrexate plus dose-adjusted EPOCH-R chemotherapy (etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab). Patients were followed for an average of 3.1 years.

Overall, 94% of all patients responded to treatment. 91% of patients had no signs of cancer after treatment.

89% of all patients were still alive 2 years later. 79% of patients were still alive 2 years later without tumor growth or spread. 9% of patients had the cancer come back in the brain or spinal cord.

Almost all (98%) of patients had severely low white blood cell levels. 26% of patients had severely low platelet levels (cells involved in blood clotting). More than half (66%) of patients had low white blood cell levels with fever. These patients recovered after treatment with antibiotics.

This study concluded that methotrexate plus chemotherapy showed promising effectiveness for patients with DLBCL. The authors suggest that this regimen may be a first-line treatment option for these patients.

This was a very small study. More studies with a larger patient population and a longer follow-up are needed to confirm these results. The effectiveness of the study regimen needs to be studied further.