Central nervous system chemoprophylaxis in non-Hodgkin lymphoma: current practice in the UK.
Central nervous system (CNS) involvement in non-Hodgkin lymphoma (NHL) is a well-recognised complication. There is no consensus regarding indications for prophylaxis or a standard CNS chemoprophylaxis regimen. Current UK practice was evaluated using a questionnaire. A total of 223 questionnaires were sent to clinicians who administered chemotherapy to patients with NHL; 158 (71%) evaluable questionnaires were returned. The overwhelming majority of respondents used prophylaxis in all cases of lymphoblastic lymphoma (97%) and Burkitt lymphoma (96%). Ninety-six per cent of respondents required risk factors to be present before prophylaxis was initiated in cases of diffuse large B-cell lymphoma. The commonest risk factor was site of involvement (paranasal sinus 88%, testicular 85%, orbital cavity 78%, bone marrow 65% and bone 28%). Other risk factors included stage IV, high International Prognostic Index score, >1 extranodal site and raised lactate dehydrogenase levels (34%, 21%, 16% and 10%). A total of 82% did not give prophylaxis in follicular lymphoma and 90% used intrathecal chemotherapy as their preferred method of prophylaxis. The most popular regimen was 12.5 mg methotrexate with each cycle of chemotherapy for six courses. Thirty-nine per cent used systemic chemotherapy for CNS prophylaxis either alone (4%) or as an adjunct to intrathecal prophylaxis (35%). These variations in the indications and methods of prophylaxis indicate that this subject deserves further review.
Cheung
C W
CW
Mount Vernon Cancer Centre, Northwood, Middlesex, UK.
Burton
C
C
Smith
P
P
Linch
D C
DC
Hoskin
P J
PJ
Ardeshna
K M
KM
D019072:Antibiotic Prophylaxis; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002051:Burkitt Lymphoma / Q000188:drug therapy; D016543:Central Nervous System Neoplasms / Q000517:prevention & control*; D018890:Chemoprevention; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy*; D008727:Methotrexate / Q000008:administration & dosage; D018579:Patient Selection; D010818:Practice Patterns, Physicians'; D054198:Precursor Cell Lymphoblastic Leukemia-Lymphoma / Q000188:drug therapy; D012307:Risk Factors; D011795:Surveys and Questionnaires; D006113:United Kingdom
D008727:Methotrexate