CNS Prophylaxis in patients with DLBC: Lymphoma Subcommittee of the Argentinian Society of Hematology experience Open Access

A multicenter retrospective study from Argentina shows the clinical management and limitations of CNS prophylaxis in patients with DLBCL.

Central nervous system (CNS) relapse in patients with diffuse large B cell lymphoma (DLBCL) is an infrequent event and the efficacy of strategies currently used to prevent it, has been challenged. This retrospective study involved two hundred sixty-two patients with DLBCL and CNS prophylaxis. Two hundred and seven (79%) patients received intrathecal therapy (ITT), 34 (13%) high doses of methotrexate (HDMTX) and 21 (8%) both. Twenty patients (7.7%) had CNS relapse with an incidence of 2.8%, 5.8% and 7.7% at 6, 12 and 24 months, respectively. No difference according to type of prophylaxis was found. OS and PFS for the entire cohort at 6, 12, and 24 months were 94% and 84%, 83% and 71%, 62% and 55%, respectively. ITT was the most commonly used prophylactic strategy, despite international guidelines favoring HD-MTX. We describe an incidence of 7.7% of CNS relapse with no difference according to type of prophylaxis. The clinical benefit of CNS prophylaxis remains an area of uncertainty; prospective studies with sufficient power are required to determine the benefits of these strategies.