This is a nice historical accounting of this sometimes-challenging paradigm. No randomized, prospective trials exist to guide practice management. The question in clinic is often, when to use prophylaxis and when not? The CNS-IPI is the best scoring system validated in the Rituximab era. This did not account for double/triple hit genetics, ABC subtypes or sites of disease (gonads, >3 sites). A high score or any of these groups are generally those that benefit the most from CNS-prophylaxis. The field has moved away from IT-MTX therapy to HD-IV-MTX since most secondary CNSL is parenchymal in nature. Most relapses occur at months 6-9 so sooner is probably better in terms of timing.
CNS relapse in the brain parenchyma, eyes, or leptomeninges is an uncommon but devastating complication of diffuse large B-cell lymphoma. CNS prophylaxis strategies, typically involving intrathecal or high-dose antimetabolites, have been developed in the front-line treatment setting with the aim to reduce this subsequent risk. Clinical and biological features associated with elevated risk are increasingly well defined and are discussed in this Review. This Review summarises both the historical and current developments in this challenging field, provides a nuanced discussion regarding current reasons for and against standard prophylactic measures, outlines evidence for the timing of prophylactic measures when delivered, and reflects on possible future developments.
Is ibrutininb’s days as a treatment for CLL over? Zanubrutinib is more effective and less toxic.
Bispecific antibody, still with toxicity though, although pts had pretreatment with obinutumzumab to mitigate CRS. Response rate 35% in pts who received CAR-T therapy.
Two words: better and safer.
This is not a randomized study, results though can not be ignored since ibrutinib is less toxic than many of the treatments used.
FCS Hematology Oncology Review creates a platform for our physician network to observe the most recent articles and studies available in the oncology and hematology world. By sharing these articles we are building our wealth of knowledge of new observations and treatments as they come available.
