Treatment strategies and risk of central nervous system recurrence in high-grade B-cell and Burkitt lymphoma.

The 2016 World Health Organization (WHO) classification has designated two categories of high-grade B-cell lymphoma (HGBCL): HGBCL with I MYC i and I BLC2 i and/or I BCL6 i rearrangements (often referred to as "double/triple-hit" lymphoma), and HGBCL, not otherwise specified [[1]]. One concern with DA-EPOCH-R is that it omits systemic central nervous system (CNS) prophylaxis, while intraparenchymal brain recurrences are increasingly frequent in DLBCL and HGBCL [[4], [10]]. Survival after recurrence was dismal (median, 1 month, 95%CI, 0.2-3.8), despite 58% of patients receiving salvage therapy, and was even worse among patients with CNS recurrence (median 0.5 vs. 1.9 month, I p i =.023, Figure 1(F)). However, our data suggest that in HGBCL, systemic HDMTX-based CNS prophylaxis may be essential, and thus support research efforts to augment DA-EPOCH-R with a suitable CNS-directed strategy for high-risk patients. [Extracted from the article]