CNS prophylaxis for diffuse large B-cell lymphoma

Toby A Eyre*, Kerry J Savage, Chan Y Cheah, Tarec C El-Galaly, Katharine L Lewis, Pamela McKay, Matthew R Wilson, Andrew M Evens, Sabela Bobillo, Diego Villa, Matthew J Maurer, Kate Cwynarski, Andrés J M Ferreri

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

1 Citation (Scopus)


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.

Original languageEnglish
JournalThe Lancet Oncology
Issue number9
Pages (from-to)e416-e426
Number of pages11
Publication statusPublished - Sep 2022

Bibliographical note

Copyright © 2022 Elsevier Ltd. All rights reserved.


  • Antineoplastic Combined Chemotherapy Protocols/therapeutic use
  • Central Nervous System Neoplasms/drug therapy
  • Humans
  • Lymphoma, Large B-Cell, Diffuse/drug therapy
  • Methotrexate/therapeutic use
  • Neoplasm Recurrence, Local/pathology


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