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

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. 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. 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). 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.