How do you approach CNS prophylaxis in patients with DLBCL?
Would you follow an algorithm such as the one proposed by Hall et al., PMID 29940062?
How do you decide between intrathecal chemotherapy vs systemic therapy with HD-MTX?
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · UCSD Radiation Oncology
Answered on
I think the NCCN-CNS-IPI based on the German data is a reasonable place to start when it comes to making decisions regarding CNS prophylaxis. We typically do IT MTX for patients on the lower end of the risk spectrum and high-dose IV MTX for patients on the higher end of the risk spectrum.
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Medical Oncology · Abramson Cancer Center, Perelman School of Medicine University of Pennsylvania
Answered on
Given the overall risk of CNS relapse for DLCL in our current era of chemoimmunotherapy is around 5%, the key to an algorithm for CNS prophylaxis is based on risk to avoid the risks of overtreatment. There are several methods of prognostication that have been published, which can identify groups wit...
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