Risk of central nervous system versus systemic relapse in patients with diffuse large B-cell lymphoma treated with R-CHOP: What should we focus on?
| Authors | |
|---|---|
| Year of publication | 2025 |
| Type | Article in Periodical |
| Magazine / Source | HemaSphere |
| MU Faculty or unit | |
| Citation | |
| web | https://onlinelibrary.wiley.com/doi/10.1002/hem3.70201 |
| Doi | https://doi.org/10.1002/hem3.70201 |
| Keywords | B-cell lymphoma; R-CHOP; central nervous system; systemic relapse |
| Description | Diffuse large B-cell lymphoma (DLBCL) is the most common hematological malignancy in adults. Although clinical outcomes of patients with DLBCL have improved over the past two decades, a significant proportion of DLBCL patients remain at risk of lymphoma relapse/progression or death due to relapse.1 Patients with high international prognostic index (IPI) or central nervous system IPI (CNS-IPI) scores face the greatest risks of systemic and CNS relapse. The CNS-IPI model has been validated in numerous studies and is widely used in clinical practice to guide decisions regarding CNS prophylaxis. However, the effectiveness of CNS prophylaxis has been repeatedly questioned in the recent retrospective studies focusing on both intrathecal (IT) and intravenous high-dose methotrexate (HD MTX). There is a lack of robust, prospective clinical trials evaluating the impact of CNS prophylaxis on the incidence of CNS relapse. As such, CNS prophylaxis may still be considered for high-risk patients, in accordance with international guidelines (NCCN?v5.2025). However, patients classified as high-risk by IPI or CNS-IPI are at risk of not only CNS relapses but also systemic relapses. The risk proportion of these two types of relapse in the same patient population has not been formally studied to date. To address this, we analyzed the competing risks of systemic versus CNS relapse in a real-world cohort of patients with DLBCL. |
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