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IT or intravenous methotrexate; which is better?

Jim M
Posts: 25
Joined: Jun 2017

Hello again,

I am receiving IT methotrexate. I read in a study or 2 that showed no protective results from IT methotrexate. The studies claimed it didn't distribute evenly in the cns, nor did it penetrate well the cerebral parenchymal. The studies showed protective results from intravenous methotrexate.

What is your experience with either application of this drug and have you been relapse free?My Dr. didn't offer me methotrexate at first, however I have testes involvement with the DLBCL. 

Thank you again for your input.

Evarista's picture
Posts: 316
Joined: May 2017

Hi Jim.  Could you provide a link to the study? Might be helpful for addressing your question.  I was told that DLBCL "likes" to home to the CNS as the reason for IT Mtx administration.

Jim M
Posts: 25
Joined: Jun 2017

Here is one link: onlinelibrary.wiley.com>doi>pdf  Or google : Intravenous methotrexate as central nervous system (CNS) prophylaxis is...

Posts: 2
Joined: Aug 2017

Hi Jim,

What did your doctor end up doing? I received intravenous as I am being treated at the hospital that did the study you cited. The sense I've gotten from my oncologist there is that the jury is really still out on what's best, but they have been using intravenous HDMTX for many years and seem to be happy with the results. I don't know much about IT, on the other hand.

catwink22's picture
Posts: 281
Joined: Sep 2009

Hi Jim,

I had it both ways. I was told the IT was preventive. I just finished my last round of chemo in late May so I dont know about relapse.

Hope you find further information.


Sal0101's picture
Posts: 133
Joined: Sep 2015


I had three IV methotrexate with leucovorin rescue treatments. They were after my 2nd, 4th, and 6th R-Chop treatments.  It was purely prophylactic because I had breast involvement, which they connected with testes involvement.   It was one of those treatments that the oncologist batted around, yes, or no several times. I'm glad I did it or I would have kicked myself in the end. Never once did they recommend intrathecal.

i did relapse with my DLBCL, but not in the CNS.  I subsequently had a stem cell transplant last September due to the relapse. 


po18guy's picture
Posts: 1183
Joined: Nov 2011

I received intrathecal methotrexate as prophylaxis prior to a stem cell transplant. The argument infavor was not compelling, and it was done more or less as a "spray and pray" tactic in case I had central nervous system involvement. In fact, the marrow biopsies did not show any such CNS involvement. If there is an advantage to IV infusion, that would avoid the possibility of infection (Meningitis is always a bad thing) from the IT administration. I would think that alone would be a strong argument in favor of IV administration.  

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