A survey evaluating hematology physicians’ perspectives on central nervous system prophylaxis

Area of Science:

• Hematology
• Oncology
• Clinical Practice Research

Background:

• Diffuse large B-cell lymphoma (DLBCL) management lacks consensus on central nervous system (CNS) prophylaxis.
• Current prophylactic strategies vary significantly across centers regarding patient selection, regimens, duration, and timing.
• This variability represents an unmet clinical need in optimizing CNS protection for DLBCL patients.

Purpose of the Study:

• To investigate current practices and perceptions regarding CNS prophylaxis in diffuse large B-cell lymphoma (DLBCL).
• To identify factors influencing prophylaxis decisions among hematologists in Turkey.
• To highlight areas of consensus and controversy in CNS prophylaxis strategies.

Main Methods:

• A survey study was conducted among hematologists under the Lymphoma Scientific Subcommittee of the Turkish Society of Haematology.
• The survey utilized the monkey survey system to collect data on prophylaxis practices and beliefs.
• Data focused on risk factors, preferred methods, and decision-making criteria for CNS prophylaxis in DLBCL.

Main Results:

• The CNS International Prognostic Index (CNS-IPI) score is frequently used and considered reliable for prophylaxis decisions.
• Breast involvement is recognized as a critical risk factor in Turkey, alongside double/triple hit or expressor lymphomas.
• Intrathecal prophylaxis is the predominantly preferred method for CNS prophylaxis in DLBCL.

Conclusions:

• Significant diversity exists in methodological and technical approaches to CNS prophylaxis for DLBCL.
• Controversial literature findings on CNS prophylaxis effectiveness may contribute to varied clinical practices.
• Standardizing practices through national guidelines could reduce variability and improve efficacy and survival follow-up studies for CNS involvement in DLBCL.