Zahid Mohammad Faizan, Khan Nadia, Hashmi Shahrukh K, Kizilbash Sani Haider, Barta Stefan K
Medical Graduate, Aga Khan University, Karachi, Pakistan.
Division of Hematologic Oncology, Department of Hematology/Oncology, Fox Chase Cancer Center, Philadelphia, PA, USA.
Eur J Haematol. 2016 Aug;97(2):108-20. doi: 10.1111/ejh.12763. Epub 2016 May 25.
Central nervous system (CNS) involvement with diffuse large B-cell lymphoma (DLBCL) is a relatively uncommon manifestation; with most cases of CNS involvement occuring during relapse after primary therapy. CNS dissemination typically occurs early in the disease course and is most likely present subclinically at the time of diagnosis in many patients who later relapse in the CNS. CNS relapse in these patients is associated with poor outcomes. Based on a CNS relapse rate of 5% in DLBCL and weighing the benefits against the toxicities, universal application of CNS prophylaxis is not justified. The introduction of rituximab has significantly reduced the incidence of CNS relapse in DLBCL. Different studies have employed other agents for CNS prophylaxis, such as intrathecal chemotherapy and high-dose systemic agents with sufficient CNS penetration. If CNS prophylaxis is to be given, it should be preferably administered during primary chemotherapy. However, there is no strong evidence that supports any single approach for CNS prophylaxis. In this review, we outline different strategies of administering CNS prophylaxis in DLBCL patients reported in literature and discuss their advantages and drawbacks.
中枢神经系统（CNS）受累于弥漫性大B细胞淋巴瘤（DLBCL）是一种相对不常见的表现；大多数中枢神经系统受累病例发生在初始治疗后的复发期间。中枢神经系统播散通常在疾病病程早期发生，并且在许多后来发生中枢神经系统复发的患者诊断时很可能以亚临床形式存在。这些患者的中枢神经系统复发与不良预后相关。基于DLBCL中枢神经系统复发率为5%，权衡其益处与毒性，普遍应用中枢神经系统预防并无依据。利妥昔单抗的引入显著降低了DLBCL中枢神经系统复发的发生率。不同的研究采用了其他药物进行中枢神经系统预防，如鞘内化疗和具有足够中枢神经系统穿透力的大剂量全身用药。如果要进行中枢神经系统预防，最好在初始化疗期间给药。然而，没有强有力的证据支持任何单一的中枢神经系统预防方法。在本综述中，我们概述了文献报道的DLBCL患者中枢神经系统预防给药的不同策略，并讨论了它们的优缺点。
