Summary of consensus guideline recommendations for CNS prophylaxis in DLBCL
| Guideline . | Patient selection . | Method for CNS prophylaxis suggested . |
|---|---|---|
| British Society for Haematology (2021)8 | Offer to: • High (4-6) CNS-IPI • ≥3 EN sites • High-risk EN site involvement—testicular, renal/adrenal, intravascular Consider in: • Breast involvement • Uterine involvement | • HD-MTX (≥3 g/m2 for 2-3 cycles) as early as possible as part of first-line therapy without compromising dose and time intensity of R-CHOP-like treatment • IT prophylaxis not recommended if HD-MTX successfully delivered • Consider IT as well as systemic prophylaxis in testicular DLBCL |
| NCCN (2022)48 | Consider in: • High (4-6) CNS-IPI • Double/triple-hit HGBL • High-risk EN site involvement—testicular, breast, primary cutaneous, renal/adrenal | • HD-MTX (3-3.5 g/m2 for 2-4 cycles) during or after the course of treatment and/or • IT methotrexate and/or cytarabine (4-8 doses) during or after the course of treatment |
| ESMO (2018)49 | Consider in: • High IPI • High-risk EN site involvement—testicular, renal/adrenal, breast, bone marrow, bone | • HD-MTX is “an option . . . even though the level of supporting evidence is low” • “Little or no role” for IT therapy |
| Guideline . | Patient selection . | Method for CNS prophylaxis suggested . |
|---|---|---|
| British Society for Haematology (2021)8 | Offer to: • High (4-6) CNS-IPI • ≥3 EN sites • High-risk EN site involvement—testicular, renal/adrenal, intravascular Consider in: • Breast involvement • Uterine involvement | • HD-MTX (≥3 g/m2 for 2-3 cycles) as early as possible as part of first-line therapy without compromising dose and time intensity of R-CHOP-like treatment • IT prophylaxis not recommended if HD-MTX successfully delivered • Consider IT as well as systemic prophylaxis in testicular DLBCL |
| NCCN (2022)48 | Consider in: • High (4-6) CNS-IPI • Double/triple-hit HGBL • High-risk EN site involvement—testicular, breast, primary cutaneous, renal/adrenal | • HD-MTX (3-3.5 g/m2 for 2-4 cycles) during or after the course of treatment and/or • IT methotrexate and/or cytarabine (4-8 doses) during or after the course of treatment |
| ESMO (2018)49 | Consider in: • High IPI • High-risk EN site involvement—testicular, renal/adrenal, breast, bone marrow, bone | • HD-MTX is “an option . . . even though the level of supporting evidence is low” • “Little or no role” for IT therapy |
ESMO, European Society for Medical Oncology; HGBL, high-grade B-cell lymphoma; NCCN, National Comprehensive Cancer Network.