How do you approach CNS prophylaxis in patients with DLBCL?

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.

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...