CNS prophylaxis for diffuse large B-cell lymphoma

Lancet Oncol. 2022 Sep;23(9):e416-e426. doi: 10.1016/S1470-2045(22)00371-0.

Abstract

CNS relapse in the brain parenchyma, eyes, or leptomeninges is an uncommon but devastating complication of diffuse large B-cell lymphoma. CNS prophylaxis strategies, typically involving intrathecal or high-dose antimetabolites, have been developed in the front-line treatment setting with the aim to reduce this subsequent risk. Clinical and biological features associated with elevated risk are increasingly well defined and are discussed in this Review. This Review summarises both the historical and current developments in this challenging field, provides a nuanced discussion regarding current reasons for and against standard prophylactic measures, outlines evidence for the timing of prophylactic measures when delivered, and reflects on possible future developments.

Publication types

  • Review
  • Research Support, N.I.H., Extramural

MeSH terms

  • Antineoplastic Combined Chemotherapy Protocols / therapeutic use
  • Central Nervous System Neoplasms* / drug therapy
  • Central Nervous System Neoplasms* / pathology
  • Central Nervous System Neoplasms* / prevention & control
  • Humans
  • Lymphoma, Large B-Cell, Diffuse* / drug therapy
  • Lymphoma, Large B-Cell, Diffuse* / pathology
  • Methotrexate / therapeutic use
  • Neoplasm Recurrence, Local / pathology

Substances

  • Methotrexate