ASCO 2023 | MTHFR polymorphisms & neurotoxicity & OS after methotrexate-based therapy in primary CNS lymphoma

Philipp Karschnia, MD, Ludwig-Maximilians-University, Munich, Germany, discusses a study evaluating the association of MTHFR polymorphisms with methotrexate (HD-MTX) related central nervous system (CNS) toxicity in primary CNS lymphoma (PCNSL) patients. Among 68 PCNSL patients, 60 had MTHFR polymorphisms. The 1298A/C genotype was linked to increased frequency and severity of leukoencephalopathy over time. This genotype predicted treatment-induced leukoencephalopathy with a sensitivity of 71.0% and a specificity of 62.2%. Patients with the 1298A/C genotype had reduced overall survival, possibly due to decreased functional status affecting their suitability for aggressive subsequent therapies. The study suggests that the MTHFR 1298A/C genotype could help identify PCNSL patients at higher risk of HD-MTX-induced leukoencephalopathy, potentially impacting their treatment outcomes. This interview took place at the American Society of Clinical Oncology (ASCO) 2023 Annual Congress in Chicago, IL.

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