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Posted by on Feb 16, 2020 in Non-Hodgkin lymphoma | 0 comments

In a nutshell

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.

Some background

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.

Methods & findings

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.

The bottom line

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.

The fine print

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.

Published By :


Date :

Oct 24, 2019

Original Title :

DA-EPOCH-R combined with high-dose methotrexate in patients with newly diagnosed stage II-IV CD5-positive diffuse large B-cell lymphoma: a single-arm, open-label, phase 2 study.

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