Open Access

ARTICLE

Intrathecal Pemetrexed Administration and Myelosuppression in Patients with Leptomeningeal Metastases from Lung Adenocarcinoma: A Retrospective Study

Junxing Chen^1,#, Luping Pan^1,#, Yunzhi Liu^1,2, Yan Fang¹, Ruoxuan Li¹, Zhiqin Lu^1,3, Anwen Liu^1,4, Yanqing He^5,*, Zhimin Zeng^1,6,*

1 Department of Oncology, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
2 School of Public Health, Nanchang University, Nanchang, 330006, China
3 Department of Radiotherapy, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Provincial Hospital of Traditional Chinese Medicine, Hangzhou, 310000, China
4 Radiation Induced Heart Damage Institute of Nanchang University, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China
5 Department of Nosocomial Infection Control, The Second Affiliated Hospital of Nanchang University, Nanchang, 330006, China
6 Jiangxi Province Key Laboratory of Immunology and Inflammation, The Second Affiliated Hospital, Jiangxi Medical College, Nanchang University, Nanchang, 330006, China

* Corresponding Authors: Yanqing He. Email: ; Zhimin Zeng. Email:
# These two authors contributed equally to this work

Oncology Research 2025, 33(8), 2107-2121. https://doi.org/10.32604/or.2025.064237

Received 09 February 2025; Accepted 29 April 2025; Issue published 18 July 2025

Abstract

Background: Non-small cell lung cancer (NSCLC) patients with leptomeningeal metastasis (LM) have a very poor prognosis. Intrathecal pemetrexed (IP) has shown moderate efficacy in treating patients with NSCLC-LM. Myelosuppression is the most common adverse effect following IP administration. Despite this trend, the specific risk factors contributing to IP-related myelosuppression remain unclear. Methods: This study conducted a retrospective analysis of lung adenocarcinoma (LUAD) patients with LM who received IP treatment at the Second Affiliated Hospital of Nanchang University from April 2017 to April 2024. Risk factors for myelosuppression were identified through univariate and multivariate logistic regression analyses. Non-linear relationships and determined the inflection points were subsequently determined using smooth curve fitting and threshold effect analysis Results: A total of 95 patients were identified, among whom 64 (68.42%) experienced myelosuppression, with 43 (45.26%) cases classified as severe myelosuppression. Leukopenia emerged as the most prevalent form of myelosuppression. Age was established as an independent risk factor for both myelosuppression and its severe form. A nonlinear relationship between age and severe myelosuppression was observed. The risk of developing severe myelosuppression increased significantly with age, beyond the turning point of 58 years old (OR 1.28, 95% CI 1.08–1.52; p = 0.0042) Conclusions: Advanced age is associated with the occurrence of myelosuppression and severe myelosuppression. The probability of developing severe myelosuppression increases significantly in individuals aged 58 years or older

---

Keywords

---