Lantz Jeffrey, Portell Craig A, Ayers Emily C
Division of Hematology and Oncology and Comprehensive Cancer Center, Department of Medicine, University of Virginia School of Medicine; Charlottesville, VA, USA.
Blood Rev. 2023 Sep;61:101101. doi: 10.1016/j.blre.2023.101101. Epub 2023 May 26.
Secondary involvement of the central nervous system (CNS) by diffuse large b-cell lymphoma (DLBCL) is a rare yet often catastrophic event for DLBCL patients. As standard first-line therapy for DLBCL with rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (R-CHOP) does not cross the blood-brain barrier, one approach to lessen the risk of CNS relapse has been to include additional agents, primarily methotrexate, directed at the CNS with standard R-CHOP although the timing, dose, and mode of administration differs widely across treating physicians. This practice derives from decades of non-randomized, often retrospective data with inconsistent outcomes. The current available tools and risk models are imprecise in their ability to predict which patients are truly at risk of secondary CNS relapse and more recent, large-scale real-world analyses call into question these longstanding practices. In a field lacking any prospective, randomized studies, this review synthesizes the available data investigating the utility of CNS prophylaxis in patients with DLBCL receiving 1st line therapy.
弥漫性大B细胞淋巴瘤（DLBCL）累及中枢神经系统（CNS）是一种罕见但对DLBCL患者而言往往是灾难性的事件。由于用于DLBCL的标准一线治疗方案利妥昔单抗、环磷酰胺、多柔比星、长春新碱和泼尼松（R-CHOP）不能穿过血脑屏障，因此降低CNS复发风险的一种方法是在标准R-CHOP方案基础上加用主要针对CNS的其他药物，主要是甲氨蝶呤，尽管不同治疗医生在用药时间、剂量和给药方式上差异很大。这种做法源于数十年的非随机、通常是回顾性的数据，结果并不一致。目前可用的工具和风险模型在预测哪些患者真正有继发CNS复发风险方面并不精确，最近的大规模真实世界分析对这些长期做法提出了质疑。在一个缺乏任何前瞻性、随机研究的领域，本综述综合了现有的数据，以研究CNS预防在接受一线治疗的DLBCL患者中的效用。
