Genomic subtypes may predict the risk of central nervous system recurrence in diffuse large B-cell lymphoma


Thomas A. Ollila, Habibe Kurt, Jozal Waroich, John Vatkevich, Ashlee Sturtevant, Nimesh R. Patel, Patrycja M. Dubielecka, Diana O. Treaba, and Adam J. Olszewski

Central nervous system (CNS) recurrence is a devastating outcome after initial therapy for diffuse large B-cell (DLBCL) or high-grade B-cell lymphoma (HGBL), yet predicting the risk of CNS recurrence and selecting patients for aggressive CNS-directed prophylaxis remains difficult. In the rituximab era, 2% to 4% of patients with DLBCL/HGBL experience a CNS recurrence.1-4  The CNS International Prognostic Index (CNS-IPI) can identify a higher-risk group (with incidence 10% to 12%), but half of events occur among patients with low/intermediate scores. Increased risk observed with the dual-expresser (MYC/BCL2) immunophenotype, double-hit HGBL with MYC and BCL2 and/or BCL6 rearrangements, as well as involvement of the bone marrow, testis, or breast, highlights the need to elucidate biology associated with the CNS invasion potential in DLBCL/HGBL.5-7 

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