title: Prevention of central nervous system relapses in diffuse large B-cell lymphoma: which patients and how?
abstract: OBJECTIVE
  This review analyzes most recent data on the risk of central nervous system (CNS) dissemination and the efficacy of current strategies for CNS prophylaxis in diffuse large B-cell lymphoma (DLBCL).
  
  
  RESULTS
  CNS dissemination still remains a rare but usually fatal complication of DLBCL. Although risk models for CNS involvement in DLBCL have been postulated on the basis of clinical findings such as more than one extranodal site, Eastern Cooperative Oncology Group performance status greater than 1, lactate dehydrogenase elevation in serum, B-symptoms, high international prognostic index score and involvement of specific sites their predictive value is relatively low. The choice of drugs and time-point for prophylaxis still remain to be defined; however, there is some evidence supporting the role of systemic CNS-penetrating chemotherapy, in particular high-dose methotrexate (>1 g/m) in the early course of disease. A role for systemic rituximab has been postulated, however, with ambiguous results among studies.
  
  
  CONCLUSIONS
  Better identification of risk factors and disease variables associated with CNS involvement in DLBCL including biological and molecular parameters is urgently needed to reduce CNS recurrences through a well designed prophylaxis regimen and to avoid unnecessary intensive and toxic treatments.
authors.affiliation: Department of Hematology and Oncology, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany. agnieszka.korfel@charite.de
authors.forename: Agnieszka
authors.initials: A
authors.lastname: Korfel
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D016543:Central Nervous System Neoplasms / Q000188:drug therapy / Q000517:prevention & control*; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy / Q000517:prevention & control*; D009364:Neoplasm Recurrence, Local / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D012307:Risk Factors