Management of DLBCL patients at high risk of brain metastasis

This article reviewed the treatment options for patients with very high-risk diffuse large B-cell lymphoma (DLBCL).

Although aggressive lymphomas are sensitive to chemotherapy, many patients do not respond well to first-line treatment. DLBCL patients with certain risk factors may develop relapsed disease in the brain. The best management approach for these high-risk patients remains under debate.

Early relapse in the brain occurs in 2.3% – 8.4% of patients with diffuse large B-cell lymphoma. Certain factors are associated with increased relapse risk after first-line treatment. These include being age 60 or older, high LDH levels, and disease at an advanced stage or outside the lymph nodes. In one study with 2196 patients treated with R-CHOP, 6% of patients had four to six of these risk factors. In these patients, the probability of relapse in the brain over 2 years was 10%.

One promising treatment option is high-dose chemotherapy containing rituximab (Rituxan) followed by stem cell transplantation (SCT). In one study of 38 patients, 63% of patients achieved a complete response (disappearance of all signs of cancer).

This article reviewed the treatment options for very high-risk lymphomas, such as early DLBCL relapse in the brain.