Central nervous system prophylaxis in diffuse large B-cell lymphoma.
Central nervous system (CNS) involvement with diffuse large B-cell lymphoma (DLBCL) is a relatively uncommon manifestation; with most cases of CNS involvement occuring during relapse after primary therapy. CNS dissemination typically occurs early in the disease course and is most likely present subclinically at the time of diagnosis in many patients who later relapse in the CNS. CNS relapse in these patients is associated with poor outcomes. Based on a CNS relapse rate of 5% in DLBCL and weighing the benefits against the toxicities, universal application of CNS prophylaxis is not justified. The introduction of rituximab has significantly reduced the incidence of CNS relapse in DLBCL. Different studies have employed other agents for CNS prophylaxis, such as intrathecal chemotherapy and high-dose systemic agents with sufficient CNS penetration. If CNS prophylaxis is to be given, it should be preferably administered during primary chemotherapy. However, there is no strong evidence that supports any single approach for CNS prophylaxis. In this review, we outline different strategies of administering CNS prophylaxis in DLBCL patients reported in literature and discuss their advantages and drawbacks.
Medical Graduate, Aga Khan University, Karachi, Pakistan.
Mohammad Faizan
MF
Zahid
Division of Hematologic Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Nadia
N
Khan
Blood and Marrow Transplant Program, Mayo Clinic Transplant Center, Mayo Clinic, Rochester, MN, USA.
Shahrukh K
SK
Hashmi
Department of Medical Oncology, Mayo Clinic, Rochester, MN, USA.
Sani Haider
SH
Kizilbash
Division of Hematologic Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.|Temple Bone Marrow Transplantation Program, Temple University Health System, Philadelphia, PA, USA.
Stefan K
SK
Barta
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000009:adverse effects / Q000627:therapeutic use*; D016543:Central Nervous System Neoplasms / Q000453:epidemiology / Q000473:pathology* / Q000517:prevention & control*; D018450:Disease Progression; D006801:Humans; D015994:Incidence; D007278:Injections, Spinal; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000453:epidemiology / Q000473:pathology*; D011292:Premedication; D012008:Recurrence; D012307:Risk Factors; D000069283:Rituximab / Q000008:administration & dosage; D016896:Treatment Outcome
D000069283:Rituximab
central nervous system; central nervous system involvement; central nervous system relapse; diffuse large B-cell lymphoma; prophylaxis