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 subc...

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Bibliographic Details
Published in:European journal of haematology 2016-08, Vol.97 (2), p.108-120
Main Authors: Zahid, Mohammad Faizan, Khan, Nadia, Hashmi, Shahrukh K., Kizilbash, Sani Haider, Barta, Stefan K.
Format: Article
Language:English
Subjects:
Antineoplastic Combined Chemotherapy Protocols - adverse effects
Antineoplastic Combined Chemotherapy Protocols - therapeutic use
central nervous system
central nervous system involvement
Central Nervous System Neoplasms - epidemiology
Central Nervous System Neoplasms - pathology
Central Nervous System Neoplasms - prevention & control
central nervous system relapse
diffuse large B-cell lymphoma
Disease Progression
Humans
Incidence
Injections, Spinal
Lymphoma, Large B-Cell, Diffuse - drug therapy
Lymphoma, Large B-Cell, Diffuse - epidemiology
Lymphoma, Large B-Cell, Diffuse - pathology
Premedication
prophylaxis
Recurrence
Risk Factors
Rituximab - administration & dosage
Treatment Outcome
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Description
Summary: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.
ISSN:0902-4441
1600-0609
DOI:10.1111/ejh.12763