Researchers from Blood Cancer Research WA have co-led the largest international study to date examining the role of central nervous system (CNS) prophylaxis in patients with ultra-high-risk large B-cell lymphoma.
Published in the Journal of Clinical Oncology, the study analysed outcomes from 1,923 patients at ultra-high risk of CNS relapse, across multiple countries to investigate whether a chemotherapy called high-dose methotrexate (HD-MTX) reduces the risk of CNS relapse in patients at the highest risk of their lymphoma spreading to the brain or spinal cord.
The international collaboration was led by Dr Matthew Wilson, Dr Katharine Lewis, Dr Amy Kirkwood and Dr Toby Eyre, with Professor Chan Cheah among the study investigators.
CNS relapse is one of the most serious complications of large B-cell lymphoma. Although uncommon, it is associated with poor outcomes, making prevention an important focus of lymphoma care. For many years, HD-MTX was widely used as preventative treatment for patients considered to be at high risk of this complication, despite limited evidence supporting its effectiveness. There have been several recent large retrospective studies suggesting that HD-MTX is not effective at preventing CNS relapse, however it has not been possible from these studies to rule out effectiveness of HD-MTX in specific high-risk subgroups.
This study found that high-dose methotrexate was not associated with a significant reduction in CNS relapse in any subgroup, providing additional important evidence to help guide discussions between clinicians and patients.
Dr Katharine Lewis, Haematologist and clinician-researcher at Blood Cancer Research WA, said the findings help answer an important clinical question that has been debated for many years.
“For patients with large B-cell lymphoma, the possibility of the disease spreading to the brain or spinal cord is one of the greatest concerns. Our study provides important evidence to help clinicians and patients have informed conversations about the potential benefits and limitations of current preventative treatment, while also highlighting the need for better strategies to reduce the risk of CNS relapse.”
Professor Chan Cheah said studies that challenge long-held assumptions are often among the most important.
“The role of CNS prophylaxis in high-risk large B-cell lymphoma has been debated for many years. This work provides valuable evidence to help guide discussions with patients and inform clinical practice.”
Professor Cheah also acknowledged the scale of the international collaboration behind the research.
“This was a tremendous collaborative effort by investigators across multiple countries, led by Matt Wilson, Kat Lewis and Toby Eyre. By working together, we were able to answer a question that no single centre could have addressed alone.”
The publication reflects Blood Cancer Research WA’s commitment to conducting research that improves care for people living with blood cancer. Through investigator-led research and international collaboration, our clinicians continue to generate evidence that helps shape the future of lymphoma treatment in Western Australia and around the world.
Congratulations to all of the investigators on this significant achievement.
Read the full publication: High-Dose Methotrexate as CNS Prophylaxis in Ultra High-Risk Large B-Cell Lymphoma: An International Multicenter Analysis, published in the Journal of Clinical Oncology.