How to Decide Which DLBCL Patients Should Receive CNS Prophylaxis.

Secondary central nervous system (CNS) relapse in aggressive non-Hodgkin lymphoma (NHL) is a dismal diagnosis with poor outcomes. While prophylaxis against secondary CNS disease is recommended in patients with highly aggressive NHLs, such as Burkitt lymphoma, patients with diffuse large B-cell lymphoma (DLBCL) present a challenging clinical dilemma due to an inherently lower risk of CNS relapse. Current guidelines suggest that prophylaxis may benefit DLBCL patients at high risk for CNS relapse; however, it has been difficult to define which patients are truly at high risk. Many studies have attempted to clarify the issue, with conflicting results. Here we review current prognostic models, risk factors, and prophylaxis methods to provide a practical approach to preventing CNS relapse in patients with DLBCL.