What is the role of CNS prophylaxis in a healthy patient in their 60s with a large DLBCL of the cranium/dura with brain parenchymal invasion?

In general, the role of CNS prophylaxis designed to prevent CNS progression in aggressive B-cell lymphomas is controversial given that it has known toxicities (infections, cytopenias) without good data to support. We still do it at our institution for patients with biologically high-risk tumors, but...

Agree there is no clear-cut answer to this question and this unusual clinical situation. For patients with brain parenchymal involvement, upfront chemotherapy with high dose methotrexate is the usual approach, followed by several options ranging from additional single agents to high dose chemo with ...