CNS in aggressive lymphomas Flashcards
1
Q
Rate of CNS relapse of DLBCL after R-CHOP
A
4%
2
Q
CNS-IPI
A
Age > 60
LDH
ECOG> 1
Stage III/IV
> 1 Extranodal site
Kidney/Adrenal involvment
3
Q
PPV of CNS-IPI
A
10-12%
Thus many pts receive prophylaxis with no need;
high NNT
4
Q
Other risk factors for CNS relapse
A
Breast/testis/uterus/epidural involvement
Double hit
CD5+ DLBCL
Intravascular lymphoma
IgM secreting DLBCL
5
Q
Lymphomas with CNS relapse rate
A
MCL
PTCL
ALK+ ALCL
6
Q
Other models
A
> 3 extranodal sites
7
Q
NPV of CNS-IPO
A
12%
8
Q
CNS prophylaxis Tx
A
IT MTX added to eah R-CHOP.
3-4 following completion of R-CHOP- 2 cycles of HD MTX after. 2-3 weeks apart.
9
Q
Dosage of HD MTX
A
3 g/m^2
If age > 70 or CKD reduce dosage to 1-1.5 g/m^2
