CNS in aggressive lymphomas

Question 1

Rate of CNS relapse of DLBCL after R-CHOP

Answer 1

4%

Question 2

CNS-IPI

Answer 2

Age > 60
LDH
ECOG> 1
Stage III/IV
> 1 Extranodal site
Kidney/Adrenal involvment

Question 3

PPV of CNS-IPI

Answer 3

10-12%
Thus many pts receive prophylaxis with no need;
high NNT

Question 4

Other risk factors for CNS relapse

Answer 4

Breast/testis/uterus/epidural involvement
Double hit
CD5+ DLBCL
Intravascular lymphoma
IgM secreting DLBCL

Question 5

Lymphomas with CNS relapse rate

Answer 5

MCL
PTCL
ALK+ ALCL

Question 6

Other models

Answer 6

> 3 extranodal sites

Question 7

NPV of CNS-IPO

Answer 7

12%

Question 8

CNS prophylaxis Tx

Answer 8

IT MTX added to eah R-CHOP.
3-4 following completion of R-CHOP- 2 cycles of HD MTX after. 2-3 weeks apart.

Question 9

Dosage of HD MTX

Answer 9

3 g/m^2
If age > 70 or CKD reduce dosage to 1-1.5 g/m^2