The use of central nervous system (CNS) prophylaxis for patients with diffuse large B-cell lymphoma (DLBCL) remains controversial. Although uncommon, CNS relapses are invariably fatal in this otherwise curable disease. Accurate identification of patients at risk and the optimal approach to CNS prophylaxis therefore remains an area of unmet need. The existing literature, largely retrospective in nature, provides mixed conclusions regarding the efficacy of CNS prophylaxis. The utility of CNS prophylaxis has itself been challenged. In this review, we dissect the issues which render the value of CNS prophylaxis uncertain. We first compare international clinical guidelines for CNS prophylaxis. We then interrogate the factors that should be used to identify high-risk patients accurately. We also explore how clinical patterns of CNS relapse have changed in the pre-rituximab and rituximab era. We then discuss the efficacy of CNS-directed approaches, intensification of systemic treatment and other novel approaches in CNS prophylaxis. Improved diagnostics for early detection of CNS relapses and newer therapeutics for CNS prophylaxis are areas of active investigation. In an area where prospective, randomized studies are impracticable and lacking, guidance for the use of CNS prophylaxis will depend on rigorous statistical review of retrospective data.

中文翻译：

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高危弥漫性大 B 细胞淋巴瘤患者中枢神经系统预防的最新进展

对于弥漫性大 B 细胞淋巴瘤 (DLBCL) 患者使用中枢神经系统 (CNS) 预防仍存在争议。尽管不常见，但中枢神经系统复发对于这种本来可以治愈的疾病来说总是致命的。因此，准确识别处于危险中的患者以及中枢神经系统预防的最佳方法仍然是一个未满足需求的领域。现有文献大多是回顾性的，对于中枢神经系统预防的功效提供了不同的结论。中枢神经系统预防的效用本身就受到了挑战。在这篇综述中，我们剖析了导致中枢神经系统预防价值不确定的问题。我们首先比较中枢神经系统预防的国际临床指南。然后我们询问应该用来准确识别高风险患者的因素。我们还探讨了利妥昔单抗之前和利妥昔单抗时代中枢神经系统复发的临床模式如何变化。然后我们讨论中枢神经系统导向方法、强化全身治疗和其他中枢神经系统预防新方法的疗效。早期检测中枢神经系统复发的改进诊断方法和中枢神经系统预防的新疗法是积极研究的领域。在前瞻性随机研究不切实际且缺乏的领域，中枢神经系统预防的使用指南将取决于对回顾性数据的严格统计审查。