Controversies and current practices in CNS relapse of diffuse large B-cell lymphoma


  • Robert Puckrin, MD, FRCPC
  • Douglas A. Stewart, MD, FRCPC



Central nervous system (CNS) relapse is an uncommon complication of diffuse large B-cell lymphoma (DLBCL), occurring in approximately 3–5% of patients and at a median timepoint of 6–9 months from diagnosis. Approximately half of these cases present as isolated CNS relapse caused by occult seeding of the CNS early in the disease course, while the remaining cases occur in the context of concurrent systemic relapse. The median survival after CNS relapse is only 4–6 months, highlighting the unmet need to identify effective prophylaxis and management strategies. This article provides an overview of current controversies and optimal strategies for prognosticating, preventing, and treating CNS relapse in patients with DLBCL.

Author Biographies

Robert Puckrin, MD, FRCPC

Dr. Robert Puckrin is a hematopoietic cell transplant and cellular therapy fellow at the University of Calgary with interests in lymphoma, transplantation, CAR-T cell therapy, and clinical research.

Douglas A. Stewart, MD, FRCPC

Dr. Douglas Stewart obtained his medical degree from the University of Alberta in 1987, completed Internal Medicine and Medical Oncology residencies at the University of Ottawa, and then completed a fellowship in Bone Marrow Transplantation and Lymphoma Management at the University of Nebraska Medical Center in Omaha. Since July 1994, Dr. Stewart has been practicing Medical Oncology at the Tom Baker Cancer Centre in Calgary, where he is a member of the Blood and Marrow Transplant Program, Hematology, and Breast Tumour groups. His clinical research activities involving lymphoma and hematopoietic stem cell transplantation have resulted in over 180 published peer-reviewed manuscripts, and in 2019 he attained the academic rank of Professor Emeritus in the Department of Oncology at the University of Calgary for services in teaching, research, and engagement. Since 2017, Dr. Stewart has held the position of Senior Medical Director of the Cancer Strategic Clinical Network for Alberta Health Services.


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How to Cite

Puckrin R, Stewart DA. Controversies and current practices in CNS relapse of diffuse large B-cell lymphoma. Can Hematol Today [Internet]. 2022 Mar. 1 [cited 2024 Apr. 15];2(1):11–14. Available from: