Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma
Abstract The use of central nervous system (CNS) prophylaxis for patients with diffuse large B-cell lymphoma (DLBCL) remains controversial. Although uncommon, CNS relapses are invariably fatal in this otherwise curable disease. Accurate identification of patients at risk and the optimal approach to...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2024-01-01
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| Series: | Experimental Hematology & Oncology |
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| Online Access: | https://doi.org/10.1186/s40164-023-00467-2 |
| _version_ | 1797363629285179392 |
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| author | Bernard Ji Guang Chua Chen Ee Low Chun En Yau Ya Hwee Tan Jianbang Chiang Esther Wei Yin Chang Jason Yongsheng Chan Eileen Yi Ling Poon Nagavalli Somasundaram Mohamed Farid Bin Harunal Rashid Miriam Tao Soon Thye Lim Valerie Shiwen Yang |
| author_facet | Bernard Ji Guang Chua Chen Ee Low Chun En Yau Ya Hwee Tan Jianbang Chiang Esther Wei Yin Chang Jason Yongsheng Chan Eileen Yi Ling Poon Nagavalli Somasundaram Mohamed Farid Bin Harunal Rashid Miriam Tao Soon Thye Lim Valerie Shiwen Yang |
| author_sort | Bernard Ji Guang Chua |
| collection | DOAJ |
| description | Abstract The use of central nervous system (CNS) prophylaxis for patients with diffuse large B-cell lymphoma (DLBCL) remains controversial. Although uncommon, CNS relapses are invariably fatal in this otherwise curable disease. Accurate identification of patients at risk and the optimal approach to CNS prophylaxis therefore remains an area of unmet need. The existing literature, largely retrospective in nature, provides mixed conclusions regarding the efficacy of CNS prophylaxis. The utility of CNS prophylaxis has itself been challenged. In this review, we dissect the issues which render the value of CNS prophylaxis uncertain. We first compare international clinical guidelines for CNS prophylaxis. We then interrogate the factors that should be used to identify high-risk patients accurately. We also explore how clinical patterns of CNS relapse have changed in the pre-rituximab and rituximab era. We then discuss the efficacy of CNS-directed approaches, intensification of systemic treatment and other novel approaches in CNS prophylaxis. Improved diagnostics for early detection of CNS relapses and newer therapeutics for CNS prophylaxis are areas of active investigation. In an area where prospective, randomized studies are impracticable and lacking, guidance for the use of CNS prophylaxis will depend on rigorous statistical review of retrospective data. |
| first_indexed | 2024-03-08T16:22:55Z |
| format | Article |
| id | doaj.art-fa15e3df52d3405f9819bde075496542 |
| institution | Directory Open Access Journal |
| issn | 2162-3619 |
| language | English |
| last_indexed | 2024-03-08T16:22:55Z |
| publishDate | 2024-01-01 |
| publisher | BMC |
| record_format | Article |
| series | Experimental Hematology & Oncology |
| spelling | doaj.art-fa15e3df52d3405f9819bde0754965422024-01-07T12:14:45ZengBMCExperimental Hematology & Oncology2162-36192024-01-0113111910.1186/s40164-023-00467-2Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphomaBernard Ji Guang Chua0Chen Ee Low1Chun En Yau2Ya Hwee Tan3Jianbang Chiang4Esther Wei Yin Chang5Jason Yongsheng Chan6Eileen Yi Ling Poon7Nagavalli Somasundaram8Mohamed Farid Bin Harunal Rashid9Miriam Tao10Soon Thye Lim11Valerie Shiwen Yang12Division of Medical Oncology, National Cancer Centre SingaporeYong Loo Lin School of Medicine, National University of SingaporeYong Loo Lin School of Medicine, National University of SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeDivision of Medical Oncology, National Cancer Centre SingaporeAbstract The use of central nervous system (CNS) prophylaxis for patients with diffuse large B-cell lymphoma (DLBCL) remains controversial. Although uncommon, CNS relapses are invariably fatal in this otherwise curable disease. Accurate identification of patients at risk and the optimal approach to CNS prophylaxis therefore remains an area of unmet need. The existing literature, largely retrospective in nature, provides mixed conclusions regarding the efficacy of CNS prophylaxis. The utility of CNS prophylaxis has itself been challenged. In this review, we dissect the issues which render the value of CNS prophylaxis uncertain. We first compare international clinical guidelines for CNS prophylaxis. We then interrogate the factors that should be used to identify high-risk patients accurately. We also explore how clinical patterns of CNS relapse have changed in the pre-rituximab and rituximab era. We then discuss the efficacy of CNS-directed approaches, intensification of systemic treatment and other novel approaches in CNS prophylaxis. Improved diagnostics for early detection of CNS relapses and newer therapeutics for CNS prophylaxis are areas of active investigation. In an area where prospective, randomized studies are impracticable and lacking, guidance for the use of CNS prophylaxis will depend on rigorous statistical review of retrospective data.https://doi.org/10.1186/s40164-023-00467-2Diffuse Large B-Cell LymphomaNon-Hodgkin’s LymphomaCentral Nervous SystemCNS ProphylaxisMethotrexate |
| spellingShingle | Bernard Ji Guang Chua Chen Ee Low Chun En Yau Ya Hwee Tan Jianbang Chiang Esther Wei Yin Chang Jason Yongsheng Chan Eileen Yi Ling Poon Nagavalli Somasundaram Mohamed Farid Bin Harunal Rashid Miriam Tao Soon Thye Lim Valerie Shiwen Yang Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma Experimental Hematology & Oncology Diffuse Large B-Cell Lymphoma Non-Hodgkin’s Lymphoma Central Nervous System CNS Prophylaxis Methotrexate |
| title | Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma |
| title_full | Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma |
| title_fullStr | Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma |
| title_full_unstemmed | Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma |
| title_short | Recent updates on central nervous system prophylaxis in patients with high-risk diffuse large B-cell lymphoma |
| title_sort | recent updates on central nervous system prophylaxis in patients with high risk diffuse large b cell lymphoma |
| topic | Diffuse Large B-Cell Lymphoma Non-Hodgkin’s Lymphoma Central Nervous System CNS Prophylaxis Methotrexate |
| url | https://doi.org/10.1186/s40164-023-00467-2 |
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