Eastern Cooperative Oncology Group

We use a score called the CNS-IPI or CNS-IPI to help determine the risk of CNS relapse in patients who do not have symptomatic CNS disease.

Now this uses clinical characteristics including age greater than 60, elevated LDH, ECOG, stage 3 or 4 disease, multiple extranodal sites of disease and particularly kidney or adrenal involvement to stratify risk.

Now this is a constantly evolving space but generally patients with a score over 4 should be evaluated for subclinical CNS disease and with an MRI brain and spine, maybe spine for parenchymal disease, and or a lumbar puncture for leptomeningeal disease, as this will change your upfront treatment options.

It's important not to forget that the risk of CNS relapse is also modified by the DLBCL itself.

know about the times that we recommend surveillance as well as when we recommend best supportive care.

And this is mostly driven by ECOG stat and performance status.

So if someone's an ECOG of three, really be leaning towards best supportive care.

First, remember, we do no harm.

So know when to kind of pull back and not be aggressive and definitely know when to surveil.

And then, of course, following closely on that is what can the patient do now? I'm going to kind of get on a little bit of a soapbox here, but we really need a specific functional assessment.

I would caution against relying on the Kernofsky or the ECOG or some other global oncology performance status score.

They are great for documenting certain things,

but the KPS or the ECOG can't really tell us what functional areas this patient is having challenges with.

KPS and ECOG are just very broad brush measures, and they don't provide a good functional assessment.

Two patients with the same KPS or ECOG score can have very different rehab needs.

For example, one may have severe balance and transfer impairment, but pretty intact cognition.

Another person may be independently mobile, but have severe fatigue, cognitive problems, and difficulty managing self-care.

Um, but in the, the clinical trials, it really depends on the trial, uh, what the, the, um, specific criteria are.

They do specify specific, uh, ECOG performance status, for example.

But in general, um, I, I think the, the eligibility is pretty broad in real-world practice.

And we have seen that in, uh, real-world cohorts that have been published since these trials have come out.