CNS prophylaxis in patients with DLBCL: Lymphoma Subcommittee of the Argentinian Society of Hematology experience
A multicenter retrospective study from Argentina shows the clinical management and limitations of CNS prophylaxis in patients with DLBCL. Central nervous system (CNS) relapse in patients with diffuse large B cell lymphoma (DLBCL) is an infrequent event and the efficacy of strategies currently used to prevent it, has been challenged. This retrospective study involved two hundred sixty-two patients with DLBCL and CNS prophylaxis. Two hundred and seven (79%) patients received intrathecal therapy (ITT), 34 (13%) high doses of methotrexate (HDMTX) and 21 (8%) both. Twenty patients (7.7%) had CNS relapse with an incidence of 2.8%, 5.8% and 7.7% at 6, 12 and 24 months, respectively. No difference according to type of prophylaxis was found. OS and PFS for the entire cohort at 6, 12, and 24 months were 94% and 84%, 83% and 71%, 62% and 55%, respectively. ITT was the most commonly used prophylactic strategy, despite international guidelines favoring HD-MTX. We describe an incidence of 7.7% of CNS relapse with no difference according to type of prophylaxis. The clinical benefit of CNS prophylaxis remains an area of uncertainty; prospective studies with sufficient power are required to determine the benefits of these strategies.
Authors
- Miguel Arturo Pavlovsky (ORCID: https://orcid.org/0000-0003-4561-3153)
- Marcela Miodosky (ORCID: https://orcid.org/0000-0003-1399-9645)
- Silvana Cugliari
- Astrid Pavlovsky (ORCID: https://orcid.org/0000-0002-2068-3721)
- Nancy Cristaldo (ORCID: https://orcid.org/0009-0004-4114-418X)
- Sofía Rivarola (ORCID: https://orcid.org/0000-0002-3302-5154)
- Juan García Altuve
- Mariana Kalmus (ORCID: https://orcid.org/0009-0004-2720-5556)
- Julia Laviano (ORCID: https://orcid.org/0000-0001-9956-6060)
- Fernando Warley (ORCID: https://orcid.org/0000-0002-2589-8190)
- Marisa Marquez
- Germán Stemmelin
- Romina Penalba
- Lorena Fiad
- Sabrina Sales Martínez (ORCID: https://orcid.org/0000-0002-0158-8104)
- Carolina Mahuad (ORCID: https://orcid.org/0000-0002-3862-8122)
- Ricardo Khalil Tannuri
- Juan Pablo Arriola
- Tomas Rivero Equiza (ORCID: https://orcid.org/0000-0003-3266-8155)
- Laura Korin (ORCID: https://orcid.org/0009-0000-1850-4993)
- Amalia Cerutti
- Ana Laura Romero
- Florencia Tomey
- Andrea Rodríguez (ORCID: https://orcid.org/0009-0006-8635-6084)
- María Orlova (ORCID: https://orcid.org/0009-0000-0906-2011)
- Graciela Alfonso (ORCID: https://orcid.org/0000-0002-4143-5065)
- Patricio Pereyra
- José Trucco (ORCID: https://orcid.org/0000-0003-3657-0470)
- Marta Zerga
- Ana Soledad Juárez Avignone
Institutions
- Hospital Británico (UY)
- Academia Nacional de Medicina (AR)
- Austral University (AR)
- Hospital Italiano de Buenos Aires (AR)
- Universidad Adventista del Plata (AR)
- Bernardino Rivadavia Natural Sciences Museum (AR)
- Spitalului Clinic de Urgență pentru Copii Maria Sklodowska Curie (RO)
- Hospital Universitario Austral (AR)
- Hospital Italiano La Plata (AR)
- Instituto Alexander Fleming (AR)
- Marie Curie Hospice (GB)
- Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (AR)
- Hospital Alemán (AR)
- Hospital Posadas (AR)
- Hospital El Cruce (AR)
- Hospital Británico de Buenos Aires (AR)
- Instituto de Oncología de Rosario (AR)
Publication Details
- Journal
- Blood Global Hematology
- Published
- 2025-11-06
- DOI
- https://doi.org/10.1016/j.bglo.2025.100047
- Primary Topic
- CNS Lymphoma Diagnosis and Treatment
- Type
- article
- Field-Weighted Citation Impact
- 0.00