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How Do Experts Proceed with CNS Lymphoma Consolidation Therapy, Follow-up?

Grzegorz Nowakowski, MD, of the Mayo Clinic, moderated a discussion on central nervous system (CNS) lymphoma with an expert panel featuring Christian Grommes, MD, of the Memorial Sloan Kettering Cancer Center; Katherine Peters, MD, PhD, of the Preston Robert Tisch Brain Tumor Center; and Avyakta Kallam, MD, of the City of Hope Comprehensive Cancer Center. To begin this segment’s discussion of CNS lymphoma consolidation therapy, Dr. Kallam described her criteria for choosing transplantation in patients and her subsequent monitoring of these patients. The larger panel then discussed how long and how often follow-up should be in patients who have apparent cure at five years after transplantation, given the possibility of disease recurrence. “Usually, a majority of patients prefer follow-up with oncology at least once a year for reassurance,” Dr. Kallam said. Dr. Peters highlighted the importance of continued imaging, noting that sessions should be spaced out to reduce patients’ “scan-xiety.” Dr. Grommes said that more data are needed, but he expects with more patients being cured that “there might be an adjustment in the guidelines to say, ‘if the patient prefers to have an image then you image, but after five years most likely it will not recur.’” The discussion moved onto brain irradiation as consolidative therapy. This type of intervention is problematic for its negative side effects and new data suggest its utility is limited compared to newer approaches. However, the clinicians agreed radiation continues to have a place in CNS lymphoma management. “I never tell my patients that it's completely off the table. I say there may be some day that you need it. You really need to focus on that multidisciplinary team when you want to take your patient to tumor board, if there is a recurrence, and to evaluate for possible clinical trials in that space,” Dr. Peters explained. ------------ Blood Cancers Today is a new publication that provides hematologists and oncologists with news, education, and information relevant to their patients and practices, with insight from experts in the field. As the online home of the publication, bloodcancerstoday.com is updated daily, with the most current information from around the specialty and multimedia content, including exclusive interviews with presenters at major medical meetings. Blood Cancers Today was developed to reach all professionals in the hematology/oncology universe, covering the latest news and analysis in leukemia, lymphoma, myeloma, myeloproliferative neoplasms, and other hematologic malignancies.