Philip Bierman, MD, professor, Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, discusses unmet needs for patients with central nervous system (CNS) involvement in aggressive subtypes of non—Hodgkin lymphoma (NHL).

There are many unmet needs for patients with CNS involvement in aggressive subtypes of NHL, and there have not been any randomized trials to date for this population, explains Bierman. Therefore, the best regimen to use in these patients is still up for debate. Additionally, the use of transplant is another area of question, though many physicians tend to recommend the procedure, says Bierman.

As far as regimens are concerned, the combination of ibrutinib (Imbruvica) and R-CHOP or lenalidomide (Revlimid) and R-CHOP may decrease the rate of CNS relapse. As it stands, most physicians believe that some sort of anthracycline-based therapy in combination with mid-cycle high-dose methotrexate is a good regimen to pursue for these patients, states Bierman.

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Philip Bierman, MD, professor, Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, discusses unmet needs for patients with central nervous system (CNS) involvement in aggressive subtypes of non–Hodgkin lymphoma (NHL).

Dr. Bierman on Unmet Needs for Patients With CNS Involvement in Aggressive NHL

Philip Bierman, MD, professor, Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, discusses central nervous system (CNS) involvement in aggressive subtypes of non-Hodgkin lymphoma (NHL).

Approximately 1% to 2% of cases of large cell lymphoma will have CNS involvement. This is sometimes called concurrent CNS and systemic lymphoma. If a patient with CNS involvement relapses, it is usually in the first few months after starting treatment. This could involve the brain parenchyma or the leptomeningeal compartment. CNS involvement occurs more frequently in NHL that has an aggressive histology such as Burkitt lymphoma.

There are guidelines on how to manage these patients from ASCO, the NCCN, and ESMO. Bierman says that most of these guidelines suggest R-CHOP with mid-cycle methotrexate. Generally, Bierman says that he suggests at least 3 g/m

 of high-dose methotrexate, as that is the level required to create micromolar concentrations in the spinal fluid, which are needed to eradicate the lymphoma.

Philip Bierman, MD, professor, Internal Medicine, Division of Oncology & Hematology, University of Nebraska Medical Center, discusses central nervous system (CNS) involvement in aggressive subtypes of non-Hodgkin lymphoma.
 

Philip Bierman, MD

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Dr. Bierman on Unmet Needs for Patients With CNS Involvement in Aggressive NHL

Dr. Bierman Discusses CNS Involvement in Aggressive NHL