Central nervous system-directed preventative therapy in adults with lymphoma.
All adult patients with Burkitt lymphoma or lymphoblastic lymphoma should receive central nervous system (CNS)-directed therapy with both intrathecal and high-dose systemic chemotherapy. There is no evidence to support the routine use of prophylactic CNS-directed therapy in any specific subgroup of adult patients with 'low grade' lymphomas. There are some anatomical sites where involvement by lymphoma is associated with a higher risk of CNS relapse. These probably include testis, breast, paranasal sinuses and the epidural space. Multivariate analyses strongly support a raised serum lactate dehydrogenase level and the involvement of more than one extranodal site as the strongest predictors of subsequent CNS relapse. A high International Prognostic Index score may replace the use of the above two factors in combination. There is evidence of good efficacy when intrathecal chemotherapy and high-dose systemic chemotherapy are used in combination. It is not clear how the best balance between the 'sensitivity' and 'specificity' of the choice of patients to receive CNS-directed therapy can be achieved.
McMillan
Andrew
A
Department of Haematology, Nottingham City Hospital, Nottingham, UK. amcmilla@ncht.trent.nhs.uk
D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D014408:Biomarkers, Tumor / Q000097:blood; D002051:Burkitt Lymphoma / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control; D016543:Central Nervous System Neoplasms / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control*; D005260:Female; D006801:Humans; D007278:Injections, Spinal; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008223:Lymphoma / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000097:blood / Q000188:drug therapy / Q000517:prevention & control; D011379:Prognosis; D012008:Recurrence; D018570:Risk Assessment
D014408:Biomarkers, Tumor; D007770:L-Lactate Dehydrogenase