How I treat patients with aggressive lymphoma at high risk of CNS relapse

Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involve...

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Bibliographic Details
Published in:Blood 2017-08, Vol.130 (7), p.867-874
Main Authors: Chin, Collin K., Cheah, Chan Yoon
Format: Article
Language:English
Subjects:
Adult
Aged
Central Nervous System Neoplasms - therapy
Female
Humans
Lymphoma, Non-Hodgkin - pathology
Lymphoma, Non-Hodgkin - therapy
Male
Middle Aged
Neoplasm Invasiveness
Neoplasm Recurrence, Local - therapy
Recurrence
Risk Factors
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Summary:Central nervous system (CNS) relapses are an uncommon yet devastating complication of non-Hodgkin lymphomas. The identification of patients at high risk of secondary CNS relapse is therefore paramount. Retrospective data indicate prophylactic CNS-directed therapies may reduce the risk of CNS involvement; however, no consensus exists about dose, timing, or route of therapy. In addition, prophylaxis is not without risk of treatment-related complications and morbidity. Here, we present a series of case vignettes highlighting our approach to common dilemmas encountered in routine clinical practice. We review the method of assessing CNS relapse risk, factors that increase the likelihood of relapse including histologic subtype, MYC rearrangement, protein expression, and extranodal involvement, and review our clinical practice based on available evidence in administering CNS-directed prophylaxis.
ISSN:0006-4971
1528-0020
DOI:10.1182/blood-2017-03-737460