Does immuno-chemotherapy reduce the risk of central nervous system disease?
The analysis of central nervous system (CNS) events occurring in elderly patients treated in the RECOVER-60 trial indicated that the addition of rituximab to CHOP reduced the risk of CNS disease.23 The guidelines of the Italian Society of Hematology for management of nodal DLBCL have stated that patients with unfavorable IPI score and involvement of bone marrow and/or more than one extranodal site of disease are at high risk of CNS disease and should be given CNS prophylaxis with intrathecal methotrexate;24 in the RECOVER-60 trial, however, intrathecal methotrexate failed to further reduce the risk of CNS disease in patients treated with R-CHOP14, with the possible exception of patients with testicular lymphoma. Because a comparison of the different forms of CNS prophylaxis has never formally been conducted, the question of the optimal prophylactic procedure is still open. Perspectives with new drugs One of the most promising new approaches in the therapy of CD20+ DLBCL is represented
