Central nervous system‐directed preventative therapy in adults with lymphoma

Summary All adult patients with Burkitt lymphoma or lymphoblastic lymphoma should receive central nervous system (CNS)‐directed therapy with both intrathecal and high‐dose systemic chemotherapy. There is no evidence to support the routine use of prophylactic CNS‐directed therapy in any specific subgroup of adult patients with ‘low grade’ lymphomas. There are some anatomical sites where involvement by lymphoma is associated with a higher risk of CNS relapse. These probably include testis, breast, paranasal sinuses and the epidural space. Multivariate analyses strongly support a raised serum lactate dehydrogenase level and the involvement of more than one extranodal site as the strongest predictors of subsequent CNS relapse. A high International Prognostic Index score may replace the use of the above two factors in combination. There is evidence of good efficacy when intrathecal chemotherapy and high‐dose systemic chemotherapy are used in combination. It is not clear how the best balance between the ‘sensitivity’ and ‘specificity’ of the choice of patients to receive CNS‐directed therapy can be achieved.