Cns Prophylaxis

It is not clear which, if any, subgroup of patients should receive CNS prophylaxis and exactly what that prophylaxis should consist of. Although the IPI correlates with a higher incidence of CNS recurrence, even patients with low-intermediate risk disease may have CNS relapse.58 A French group has shown that CNS prophylaxis with systemic and intrathecal methotrexate may decrease the incidence of CNS relapse compared with reported incidence in the literature,13 but most investigators agree that prospectively designed studies delineating the optimal prophylactic and treatment strategy are still needed.

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