CNS prophylaxis for diffuse large B-cell lymphoma.

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.
Competing Interests: Declaration of interests TCE-G is partly funded from a grant from the Danish Cancer Society. AJMF declares research funding from ADC Therapeutics, Bayer HealthCare Pharmaceuticals, Beigene, Bristol Myers Squibb (BMS), Genmab, Gilead, Hutchison Medipharma, Incyte, Janssen Research & Development, MEI Pharma, Novartis, PletixaPharm, Pharmacyclics, Protherics, Roche, and Takeda; consulting fees from Gilead, Juno, Novartis, PletixaPharm, and Roche; speaker fees from Gilead and Roche; and advisory work for Gilead, Juno, Novartis, PletixaPharm, and Roche. PM declares speaker fees from Janssen. TAE declares advisory work from Janssen, Kite Pharma, Roche, AbbVie, AstraZeneca, Loxo Oncology, Beigene, Incyte, and Secura Bio; speaker bureau fees from Janssen, Kite Pharma, Roche, AbbVie, AstraZeneca, Loxo Oncology, Beigene, and Incyte; and travel support from Roche and AbbVie. MJM recognises the National Cancer Institute: University of Iowa Mayo Clinic Lymphoma SPORE (P50-CA097274) grant; declares advisory work from Adaptive Biotechnologies, Pfizer, Kite Pharma, and Genmab; and research support from BMS, Genentech, Genmab, and Morphosys to his institution. KLL declares speaker bureau from Janssen, AstraZeneca, and Roche; travel support from Novartis and Janssen; and advisory work from IQVIA and Loxo at Lilly. KC declares consulting fees from Roche, BMS, KITE Pharma, and Janssen; speaker bureau from Roche, KITE Pharma, and BMS; and travel support from Roche, KITE Pharma, and BMS. CYC declares speaker bureau from Beigene, Janssen, and Gilead; and advisory work from TG Therapeutics, Roche, Novartis, Janssen, Beigene, AstraZeneca, Eli Lilly, BMS, Gilead, and BMS. KJS declares advisory work from BMS, Seattle Genetics, Merck, Janssen, Novartis, and Kyowa; and DSMC Regeneron, Steering Committee Beigene, research funding from BMS. TCE-G declares previous employment with Roche (March, 2019 until February, 2021) and an honorarium from AbbVie. All other authors declare no competing interests.
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