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Prevention of central nervous system relapses in diffuse large B-cell lymphoma: which patients and how?

Korfel, Agnieszka

doi: 10.1097/CCO.0b013e3283499c7c
Lymphoma: Edited by Bertrand Coiffier and Anne-Sophie Michallet
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Purpose of review 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).

Recent findings 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/m2) in the early course of disease. A role for systemic rituximab has been postulated, however, with ambiguous results among studies.

Summary 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.

Department of Hematology and Oncology, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Berlin, Germany

Correspondence to Agnieszka Korfel, Department of Hematology and Oncology, Charite Universitätsmedizin Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12200 Berlin, GermanyTel: +49 30 8445 4096; e-mail: agnieszka.korfel@charite.de

© 2011 Lippincott Williams & Wilkins, Inc.