Prophylactic CNS directed therapy in systemic diffuse large B cell lymphoma |
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| Affiliation: | 1. Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland;2. Faculty of Medicine, Geneva University, Switzerland;3. Department of Radiation Oncology, Bern University Hospital, Bern, Switzerland;1. Department of Internal Medicine, University of South Florida, Tampa, FL;2. Department of Blood and Marrow Transplantation and Cellular Immunotherapy, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;3. Department of Hematopathology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;4. Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN;5. Department of Internal Medicine, State University of New York at Buffalo, Erie County Medical Center, Buffalo, NY;6. Program for Comparative Effectiveness Research, University of South Florida Morsani College of Medicine, Tampa, FL;7. Department of Malignant Hematology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL;1. Department of Hematology, Ege University School of Medicine, İzmir, Turkey;2. Department of Pathology, Ege University School of Medicine, İzmir, Turkey;1. 4th Department of Internal Medicine - Haematology, Charles University, Hospital and Faculty of Medicine, Hradec Králové, Czech Republic;2. Department of Hematology, University Hospital Olomouc, Olomouc, Czech Republic;3. Department of Internal Medicine – Hematology and Oncology, Masaryk University and University Hospital Brno, Brno, Czech Republic;4. Department of Pathology and Molecular Medicine, 2nd Faculty of Medicine, Charles University and Faculty Hospital in Motol, Prague, Czech Republic;5. 1st Department of Medicine, First Medical Faculty, Charles University and General University Hospital, Prague, Czech Republic;6. Department of Oncology, Hospital Ceske Budejovice, Ceske Budejovice, Czech Republic;7. Department of Clinical Hematology, Teaching Hospital Ostrava, Ostrava, Czech Republic;8. Internal Clinic of Haematology, University Hospital Kralovske Vinohrady, Prague, Charles University in Prague, 3rd Faculty of Medicine, Prague, Czech Republic |
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| Abstract: | ![]()
Overall survival in diffuse large B-cell lymphoma (DLBCL) has significantly improved in the last decade, especially after the incorporation of rituximab. Involvement of the central nervous system (CNS) at presentation or at recurrence is an uncommon event, but carries a dismal prognosis with median survival of less than 6 months. Although prophylactic CNS directed therapy is a widely used approach to prevent this complication, randomized clinical trials have been very limited. CNS prophylaxis has inherent toxicities; therefore, identifying the population of patients who would receive most benefit is of utmost importance. From an extensive review of current literature, we report the incidence of CNS relapse in DLBCL and describe the role of CNS prophylaxis in the post-rituximab compared to the pre-rituximab era. We also review the current modalities of CNS prophylaxis and attempt to identify the high-risk patients who would benefit. Lastly, we present a treatment algorithm that defines the role of CNS prophylaxis in the management of patients with DLBCL. |
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| Keywords: | CNS Prophylaxis Diffuse large B cell Lymphoma |
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