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Genser L, Tresallet C, Le Bian AZ. De Novo Antral Stenosis After Chemotherapy for Primary Malignant Gastric Lymphoma. Am Surg 2020; 88:2939-2940. [PMID: 33125275 DOI: 10.1177/0003134820951502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Laurent Genser
- Department of Digestive Surgery-Hôpital Avicenne, Université Paris XIII, Bobigny, France
| | - Christophe Tresallet
- Department of Digestive Surgery-Hôpital Avicenne, Université Paris XIII, Bobigny, France
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2
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Avilés A, Nambo MJ, Neri N. Primary gastric diffuse large B-cell lymphoma: The role of dose-dense chemotherapy. J Oncol Pharm Pract 2018; 25:1682-1686. [PMID: 30370804 DOI: 10.1177/1078155218809458] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess if the use of a dose-dense regimen of chemotherapy can improve the prognosis in patients with primary gastric diffuse large B-cell lymphoma in early stages (I-II) but associated with worse prognostic factors. METHODS One hundred and eight consecutive patients with primary gastric diffuse large B-cell lymphoma in early stages (I-II) with high serum levels of lactic dehydrogenase and beta 2 microglobulin (more than >2 of normal levels), which were associated with a worse prognostic outcome, were treated with a dose-dense chemotherapy: CHOP with increased doses of cyclophosphamide and doxorubicin, was administered every 14 days (instead of 21 days). The end points of this study were to improve outcome measured from progression-free survival and overall survival and to evaluate acute toxicities. RESULTS Complete response was achieved in 85 patients (78%). Actuarial curves at five years show that progression-free survival was 82% and overall survival was 85%. Hematological toxicities were severe, but no death-related treatment was observed. CONCLUSIONS We considered that in this setting of patients, the use of a dose-dense regimen could be of benefit because it improves outcome and toxicities were well controlled.
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Affiliation(s)
- Agustin Avilés
- 1 Oncology Research Unit, National Medical Center, México D.F., Mexico
| | - Maria-Jesus Nambo
- 2 Department of Hematology, National Medical Center, México D.F., Mexico
| | - Natividad Neri
- 2 Department of Hematology, National Medical Center, México D.F., Mexico
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Jamet P, Matysiak-Budnik T, Brichet L, Ruskoné-Fourmestraux A. Les lymphomes gastro-intestinaux. ONCOLOGIE 2018. [DOI: 10.3166/onco-2018-0016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Matysiak-Budnik T, Fabiani B, Hennequin C, Thieblemont C, Malamut G, Cadiot G, Bouché O, Ruskoné-Fourmestraux A. Gastrointestinal lymphomas: French Intergroup clinical practice recommendations for diagnosis, treatment and follow-up (SNFGE, FFCD, GERCOR, UNICANCER, SFCD, SFED, SFRO, SFH). Dig Liver Dis 2018; 50:124-131. [PMID: 29301732 DOI: 10.1016/j.dld.2017.12.006] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 11/26/2017] [Accepted: 12/04/2017] [Indexed: 12/11/2022]
Abstract
INTRODUCTION This document is a summary of the French Intergroup guidelines on the management of gastro-intestinal lymphomas, available on the web-site of the French Society of Gastroenterology, SNFGE (www.tncd.org), updated in September 2017. METHODS This collaborative work was realised under the auspices of several French medical societies and involved clinicians with specific expertise in the field of gastrointestinal lymphomas, including gastroenterologists, haematologists, pathologists, and radiation oncologist, representing the major French or European clinical trial groups. It summarises their consensus on the management of gastrointestinal lymphomas, based on the recent literature data, previous published guidelines and the expert opinions. RESULTS The clinical management, and especially the therapeutic strategies of the gastro-intestinal lymphomas are specific to their histological subtypes and to their locations in the digestive tract, with the particularity of gastric MALT lymphomas which are the most frequent and usually related to gastritis induced by Helicobacter pylori. CONCLUSION Lymphomas are much less common than epithelial tumours of gastro-intestinal digestive tract. Their different histological subtypes determine their management and prognosis. Each individual case should be discussed within the expert multidisciplinary team.
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Affiliation(s)
- Tamara Matysiak-Budnik
- Institut des Maladies de l'Appareil Digestif, CHU, Hôtel Dieu, GELD (Groupe d'Etude des Lymphomes Digestifs), Nantes, France, France.
| | - Bettina Fabiani
- GHU Est Parisien-Hôpital St. Antoine, APHP, GELD, Paris, France
| | - Christophe Hennequin
- GHU Paris Nord-Hôpital St. Louis, APHP, LYSA (Lymphoma Study Association), Paris, France
| | - Catherine Thieblemont
- GHU Paris Nord-Hôpital St. Louis, APHP, LYSA (Lymphoma Study Association), Paris, France
| | - Georgia Malamut
- GHU Ouest- Hôpital Européen Georges Pompidou, APHP, CELAC (Centre d'Expert national des Lymphomes Associés à la maladie Coeliaque), Paris, France
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Li J, Zhou C, Liu W, Sun X, Meng X. Synchronous diffuse large B-cell lymphoma of the stomach and small cell lung carcinoma: A case report. Medicine (Baltimore) 2017; 96:e8873. [PMID: 29390275 PMCID: PMC5815687 DOI: 10.1097/md.0000000000008873] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2017] [Revised: 10/29/2017] [Accepted: 11/04/2017] [Indexed: 11/26/2022] Open
Abstract
RATIONALE The synchronous occurrence of lung cancer in patients with gastric neoplasms is relatively uncommon, especially the cases of synchronous coexistence of small cell lung carcinoma and diffuse large B-cell lymphoma of the stomach. PATIENT CONCERNS We encountered a case of synchronous primary small cell lung carcinoma and diffuse large B-cell lymphoma of the stomach. A 63-year-old patient with a 7.5 × 5.09 cm mass in the superior lobe of the right lung diagnosed with small cell lung cancer and synchronous diffuse large B-cell lymphoma of the stomach. DIAGNOSES The diseases were diagnosed by the pathological biopsy and immunohistochemical methods. INTERVENTIONS As the patient received CHOP chemotherapy, pulmonary function deterioraed. Etoposide was added to the chemotherapy. OUTCOMES However, after the first treatment, chest computed tomography showed that the mass in the superior lobe of the right lung had increased to 8.5 × 5.2 cm. LESSONS This report draws attention to the fact that the treatment of synchronous tumors is a challenge.
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MESH Headings
- Antineoplastic Combined Chemotherapy Protocols
- Biopsy
- Carcinoma, Small Cell/diagnosis
- Carcinoma, Small Cell/drug therapy
- Carcinoma, Small Cell/pathology
- Cyclophosphamide
- Doxorubicin
- Female
- Gastroscopy
- Humans
- Immunohistochemistry
- Lung Neoplasms/diagnosis
- Lung Neoplasms/drug therapy
- Lung Neoplasms/pathology
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Middle Aged
- Neoplasms, Multiple Primary/diagnosis
- Neoplasms, Multiple Primary/drug therapy
- Neoplasms, Multiple Primary/pathology
- Prednisone
- Stomach Neoplasms/diagnosis
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/pathology
- Tomography, X-Ray Computed
- Vincristine
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Affiliation(s)
- Jia Li
- From the Department of Gastroenterology, First Hospital of Jilin University
| | - Changli Zhou
- From the Department of Internal medicine, Nursing School of Jilin University
| | - Wanqi Liu
- From the Department of Gastroenterology
| | - Xun Sun
- From the Department of Pathology
| | - Xiangwei Meng
- From the Department of Gastroenterology, First Hospital of Jilin University, Changchun, Jilin, China
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6
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Montalbán C, Díaz-López A, Dlouhy I, Rovira J, Lopez-Guillermo A, Alonso S, Martín A, Sancho JM, García O, Sánchez JM, Rodríguez M, Novelli S, Salar A, Gutiérrez A, Rodríguez-Salazar MJ, Bastos M, Domínguez JF, Fernández R, Gonzalez de Villambrosia S, Queizan JA, Córdoba R, de Oña R, López-Hernandez A, Freue JM, Garrote H, López L, Martin-Moreno AM, Rodriguez J, Abraira V, García JF. Validation of the NCCN-IPI for diffuse large B-cell lymphoma (DLBCL): the addition of β 2 -microglobulin yields a more accurate GELTAMO-IPI. Br J Haematol 2017; 176:918-928. [PMID: 28106247 DOI: 10.1111/bjh.14489] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 10/10/2016] [Indexed: 12/18/2022]
Abstract
The study included 1848 diffuse large B-cell lymphoma (DLBCL)patients treated with chemotherapy/rituximab. The aims were to validate the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) and explore the effect of adding high Beta-2 microglobulin (β2M), primary extranodal presentation and intense treatment to the NCCN-IPI variables in order to develop an improved index. Comparing survival curves, NCCN-IPI discriminated better than IPI, separating four risk groups with 5-year overall survival rates of 93%, 83%, 67% and 49%, but failing to identify a true high-risk population. For the second aim the series was split into training and validation cohorts: in the former the multivariate model identified age, lactate dehydrogenase, Eastern Cooperative Oncology Group performance status, Stage III-IV, and β2M as independently significant, whereas the NCCN-IPI-selected extranodal sites, primary extranodal presentation and intense treatments were not. These results were confirmed in the validation cohort. The Grupo Español de Linfomas/Trasplante de Médula ósea (GELTAMO)-IPI developed here, with 7 points, significantly separated four risk groups (0, 1-3, 4 or ≥5 points) with 11%, 58%, 17% and 14% of patients, and 5-year overall survival rates of 93%, 79%, 66% and 39%, respectively. In the comparison GELTAMO IPI discriminated better than the NCCN-IPI. In conclusion, GELTAMO-IPI is more accurate than the NCCN-IPI and has statistical and practical advantages in that the better discrimination identifies an authentic high-risk group and is not influenced by primary extranodal presentation or treatments of different intensity.
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Affiliation(s)
- Carlos Montalbán
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | - Antonio Díaz-López
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Ivan Dlouhy
- Department of Haematology, Hospital Clinic, Barcelona, Spain
| | - Jordina Rovira
- Department of Haematology, Hospital Clinic, Barcelona, Spain
| | | | - Sara Alonso
- Department of Haematology, Hospital Universitario and IBSAL, Salamanca, Spain
| | - Alejandro Martín
- Department of Haematology, Hospital Universitario and IBSAL, Salamanca, Spain
| | - Juan M Sancho
- Department of Haematology, Hospital Germans Trias i Pujol, ICO-IJC, Badalona, Spain
| | - Olga García
- Department of Haematology, Hospital Germans Trias i Pujol, ICO-IJC, Badalona, Spain
| | - Jose M Sánchez
- Department of Haematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Mario Rodríguez
- Department of Haematology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Silvana Novelli
- Department of Haematology, Hospital de la Santa Creu I Sant Pau, Barcelona, Spain
| | - Antonio Salar
- Department of Haematology, Hospital del Mar, Barcelona, Spain
| | - Antonio Gutiérrez
- Department of Haematology, Hospital Universitari Son Espases, Palma de Mallorca (IdISPa), Spain
| | | | - Mariana Bastos
- Department of Haematology, Hospital Gregorio Marañón, Madrid, Spain
| | - Juan F Domínguez
- Department of Haematology, Hospital Virgen del Rocío, Sevilla, Spain
| | - Rubén Fernández
- Department of Haematology, Hospital de Cabueñes, Gijón, Spain
| | | | - José A Queizan
- Department of Haematology, Hospital General de Segovia, Segovia, Spain
| | - Raul Córdoba
- Department of Haematology, Fundación Jimenez Díaz, Madrid, Spain
| | - Raquel de Oña
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | | | - Julian M Freue
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Heidys Garrote
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | - Lourdes López
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain
| | | | - Jose Rodriguez
- Department of Haematology, MD Anderson Cancer Centre, Madrid, Spain
| | - Víctor Abraira
- Hospital Universitario Ramón y Cajal, IRYCIS, Madrid, Spain
| | - Juan F García
- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.,Department of Pathology, MD Anderson Cancer Centre, Madrid, Spain
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- Department of Translational Research, MD Anderson Cancer Centre, Madrid, Spain.,Department of Pathology, MD Anderson Cancer Centre, Madrid, Spain
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Clinical Outcome of Eradication Therapy for Gastric Mucosa-Associated Lymphoid Tissue Lymphoma according to H. pylori Infection Status. Gastroenterol Res Pract 2016; 2016:6794848. [PMID: 27034656 PMCID: PMC4789472 DOI: 10.1155/2016/6794848] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2015] [Accepted: 02/07/2016] [Indexed: 12/21/2022] Open
Abstract
Background. To evaluate the long-term outcome of H. pylori eradication therapy for gastric MALT lymphoma according to the presence of H. pylori infection. Methods. We retrospectively reviewed the medical records of patients between January 2001 and June 2014. The clinicopathologic characteristics and clinical outcomes were compared between H. pylori-positive and H. pylori-negative gastric MALT lymphoma groups. Results. Fifty-four patients were enrolled: 12 H. pylori-negative and 42 H. pylori-positive patients. The tumor was located more frequently in both the proximal and distal parts of the stomach (P = 0.001), and the percentage of multiple lesions was significantly greater in the H. pylori-negative group (P = 0.046). Forty-seven patients received initial eradication therapy, and 85% (35/41) of H. pylori-positive patients and 50% (3/6) of H. pylori-negative patients achieved complete remission after eradication therapy. The presence of multiple lesions was a predictive factor for unresponsiveness to H. pylori eradication (P = 0.024). The efficacy of eradication therapy (P = 0.133), complete remission (CR) maintenance period, and relapse after eradication therapy were not significantly different between the two groups. Conclusions. H. pylori eradication therapy could be an effective first-line treatment for localized H. pylori-negative gastric MALT lymphoma, especially for single lesions.
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Thein AW, Myint AA, Khaing SH, Shinde SV, Maw M. Chemotherapy versus surgery with or without adjuvant chemotherapy and radiotherapy for localised primary gastric diffuse large B-cell lymphoma. Hippokratia 2016. [DOI: 10.1002/14651858.cd009914.pub2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
- Aung Win Thein
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
| | - Aye Aye Myint
- Monash University; Department of Medicine; Johor Bahru Johor Malaysia 80100
| | - Saw Hla Khaing
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
| | - Shyamkant Vithal Shinde
- Melaka-Manipal Medical College; Department of Paediatrics; Jalan Batu Hampar Bukit Baru Melaka Melaka Malaysia 75150
| | - Myat Maw
- Melaka-Manipal Medical College; Department of Surgery; Jalan Batu Hampar, Bukit Baru Melaka Melaka Malaysia 75150
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9
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Sachanas S, Pangalis GA, Kalpadakis C, Levidou G, Yiakoumis X, Moschogiannis M, Kyrtsonis MC, Vassilakopoulos TP, Tsirkinidis P, Siakantaris M, Spiliadi C, Karagianni E, Korkolopoulou P, Rontogianni D, Papadaki H, Panayiotidis P, Angelopoulou M. Extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) with concurrent high grade component at diagnosis: clinico-pathologic features and treatment strategy. Leuk Lymphoma 2015; 56:3230-2. [PMID: 25827212 DOI: 10.3109/10428194.2015.1034698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Sotirios Sachanas
- a Department of Haematology , Athens Medical Center-Psychikon Branch , Athens , Greece
| | - Gerassimos A Pangalis
- a Department of Haematology , Athens Medical Center-Psychikon Branch , Athens , Greece
| | - Christina Kalpadakis
- b Department of Haematology , Heraklion University Hospital of Crete , Heraklion, Crete , Greece
| | - Georgia Levidou
- c Department of Pathology , University of Athens , Athens , Greece
| | - Xanthi Yiakoumis
- a Department of Haematology , Athens Medical Center-Psychikon Branch , Athens , Greece
| | - Maria Moschogiannis
- a Department of Haematology , Athens Medical Center-Psychikon Branch , Athens , Greece
| | | | | | - Pantelis Tsirkinidis
- a Department of Haematology , Athens Medical Center-Psychikon Branch , Athens , Greece
| | - Marina Siakantaris
- e First Department of Internal Medicine , University of Athens, Laikon General Hospital , Athens , Greece
| | | | | | | | | | - Helen Papadaki
- b Department of Haematology , Heraklion University Hospital of Crete , Heraklion, Crete , Greece
| | - Panayiotis Panayiotidis
- d Department of Haematology , University of Athens, Laikon General Hospital , Athens , Greece
| | - Maria Angelopoulou
- d Department of Haematology , University of Athens, Laikon General Hospital , Athens , Greece
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10
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Abstract
Primary gastrointestinal (GI) lymphomas are uncommon diseases that can involve the whole GI tract. The etiologies of the disease remain unclear, and potential risk factors include celiac disease, Helicobacter pylori infection, use of immunosuppressive agents, human immunodeficiency virus (HIV) or Epstein-Barr virus (EBV) infection and inflammatory bowel disease, etc. Diffuse large B-cell lymphoma (DLBCL) and mucosa-associated lymphoid tissue (MALT) lymphoma are the most common subtypes of GI lymphomas. B-cell lymphomas of the GI tract are more common in Western countries, while in Asia-Pacific region T-cell lymphomas are more frequently reported. In this review, lymphomas in the esophagus, stomach and intestine are described, including their epidemiology, histology, clinical manifestations, endoscopic findings, radiological features and treatment.
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Affiliation(s)
- Jiang Chen Peng
- State Key Laboratory for Oncogenes and Related Genes, Key Laboratory of Gastroenterology & Hepatology, Ministry of Health, Division of Gastroenterology and Hepatology, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai Cancer Institute, Shanghai Institute of Digestive Disease, Shanghai Inflammatory Bowel Disease Research Center, Shanghai, China
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11
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Yan SY, Peng YJ, Lin CS, Peng GS, Chang PY. Isolated oculomotor nerve palsy as a paraneoplastic manifestation of gastric diffuse large B-cell lymphoma: A case report. Oncol Lett 2014; 8:1983-1985. [PMID: 25295082 PMCID: PMC4186600 DOI: 10.3892/ol.2014.2454] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2014] [Accepted: 07/11/2014] [Indexed: 12/03/2022] Open
Abstract
Isolated oculomotor nerve palsy (ONP) is rare. The major causes are aneurysm of the posterior communicating artery, microvascular ischemia, neoplasm, inflammation and trauma. The present study reports the case of a 72-year-old female with left isolated pupil-sparing ONP and severe anemia as the initial manifestations of gastric diffuse large B-cell lymphoma (DLBCL). Systemic chemotherapy without any central nervous system (CNS)-directed treatment led to a complete resolution of the ONP, suggesting that it was most likely to be a paraneoplastic phenomenon. If CNS involvement cannot be demonstrated by brain magnetic resonance imaging and cerebrospinal fluid assessment, the present case suggests that it may be acceptable to omit CNS-directed therapy in such cases of ONP, since it may be paraneoplastic in nature and may resolve following successful treatment of the underlying malignancy.
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Affiliation(s)
- Shang-Yih Yan
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Yi-Jen Peng
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Chun-Shu Lin
- Department of Radiation Oncology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Giia-Sheun Peng
- Department of Neurology, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
| | - Ping-Ying Chang
- Division of Hematology/Oncology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei 114, Taiwan, R.O.C
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12
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Kuo SH, Yeh KH, Chen LT, Lin CW, Hsu PN, Hsu C, Wu MS, Tzeng YS, Tsai HJ, Wang HP, Cheng AL. Helicobacter pylori-related diffuse large B-cell lymphoma of the stomach: a distinct entity with lower aggressiveness and higher chemosensitivity. Blood Cancer J 2014; 4:e220. [PMID: 24949857 PMCID: PMC4080211 DOI: 10.1038/bcj.2014.40] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2014] [Revised: 04/12/2014] [Accepted: 05/12/2014] [Indexed: 12/17/2022] Open
Abstract
We recently showed that Helicobacter pylori (HP)-positive gastric ‘pure' diffuse large B-cell lymphoma (DLBCL) may respond to HP eradication therapy. However, whether these HP-related ‘pure' DLBCL of the stomach may differ fundamentally from those unrelated to HP remains unclear. In this study, we compared the clinicopathologic features of these two groups of patients who had been uniformly treated by conventional chemotherapy. Forty-six patients were designated HP-positive and 49 were HP-negative by conventional criteria. HP-positive patients had a lower International Prognostic Index score (0–1, 65% vs 43%, P=0.029), a lower clinical stage (I-IIE1, 70% vs 39%, P=0.003), a better tumor response to chemotherapy (complete pathologic response, 76% vs 47%, P=0.004) and significantly superior 5-year event-free survival (EFS) (71.7% vs 31.8%, P<0.001) and overall survival (OS) (76.1% vs 39.8%, P<0.001). To draw a closer biologic link with HP, HP-positive tumors were further examined for CagA expression in lymphoma cells. Compared with CagA-negative cases (n=16), CagA-positive cases (n=27) were associated with high phosphorylated SHP-2 expression (P=0.016), and even better 5-year EFS (85.2% vs 46.3%, P=0.002) and OS (88.9% vs 52.9%, P=0.003). HP-related gastric ‘pure' DLBCL may be a distinct tumor entity, which is less aggressive, and responds better to conventional chemotherapy.
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Affiliation(s)
- S-H Kuo
- 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [3] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [4] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - K-H Yeh
- 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [3] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - L-T Chen
- 1] Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan [2] Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan [3] Department of Internal Medicine, National Cheng-Kung University Hospital, Tainan, Taiwan
| | - C-W Lin
- Department of Pathology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - P-N Hsu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - C Hsu
- 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [3] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan
| | - M-S Wu
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Y-S Tzeng
- 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan
| | - H-J Tsai
- 1] Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan [2] Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - H-P Wang
- Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - A-L Cheng
- 1] Department of Oncology, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [2] Department of Internal Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan [3] Cancer Research Center, National Taiwan University College of Medicine, Taipei, Taiwan [4] Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei, Taiwan [5] Institute of Cancer Research, National Health Research Institutes, Tainan, Taiwan
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13
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Kuo SH, Cheng AL. Helicobacter pylori and mucosa-associated lymphoid tissue: what's new. HEMATOLOGY. AMERICAN SOCIETY OF HEMATOLOGY. EDUCATION PROGRAM 2013; 2013:109-117. [PMID: 24319171 DOI: 10.1182/asheducation-2013.1.109] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
Abstract
Low-grade mucosa-associated lymphoid tissue (MALT) lymphoma of the stomach, gastric MALT lymphoma, is associated with Helicobacter pylori infection. The eradication of H pylori using antibiotics is successful in 60% to 80% of affected patients. In contrast to the previous paradigm, we and other investigators have shown that a certain proportion of patients with H pylori-positive early-stage diffuse large B-cell lymphoma (DLBCL) of the stomach with histological evidence of MALT lymphoma, including high-grade transformed gastric MALT lymphoma and gastric DLBCL(MALT), achieved long-term complete pathological remission (pCR) after first-line H pylori eradication therapy, indicating that the loss of H pylori dependence and high-grade transformation are separate events in the progression of gastric lymphoma. In addition, patients with H pylori-positive gastric DLBCL without histological evidence of MALT (gastric pure DLBCL) may also respond to H pylori eradication therapy. A long-term follow-up study showed that patients who achieved pCR remained lymphoma free. Gastric MALT lymphoma is indirectly influenced by H pylori infection through T-cell stimulation, and recent studies have shown that H pylori-triggering chemokines and their receptors, H pylori-associated epigenetic changes, H pylori-regulated miRNA expression, and tumor infiltration by CD4+CD25+ regulatory T cells contribute to lymphomagenesis of gastric MALT lymphoma. Recent studies have also demonstrated that the translocation of CagA into B lymphocytes inhibits apoptosis through p53 accumulation, BAD phosphorylation, and the up-regulation of Bcl-2 and Bcl-XL expression. In gastric MALT lymphoma, CagA may stimulate lymphomagenesis directly, through the regulation of signal transduction, and intracellular CagA is associated with H pylori dependence. These findings represent a substantial paradigm shift compared with the classical theory of H pylori-reactive T cells contributing indirectly to the development of MALT lymphoma. In conclusion, a wide range of H pylori-related gastric lymphomas have been identified. The use of antibiotics as the sole first-line therapy for early-stage gastric pure DLBCL requires validation in a prospective study. The clinical and biological significance of the CagA oncoprotein in the lymphomagenesis of gastric MALT lymphoma warrants further study.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- B-Lymphocytes/immunology
- B-Lymphocytes/metabolism
- Cell Transformation, Neoplastic/genetics
- Cell Transformation, Neoplastic/immunology
- Cell Transformation, Neoplastic/metabolism
- Epigenesis, Genetic/immunology
- Gastric Mucosa/immunology
- Gastric Mucosa/metabolism
- Gastric Mucosa/microbiology
- Helicobacter Infections/genetics
- Helicobacter Infections/immunology
- Helicobacter Infections/metabolism
- Helicobacter Infections/therapy
- Helicobacter pylori/genetics
- Helicobacter pylori/immunology
- Helicobacter pylori/metabolism
- Humans
- Lymphoid Tissue/immunology
- Lymphoid Tissue/metabolism
- Lymphoid Tissue/microbiology
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/metabolism
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Large B-Cell, Diffuse/genetics
- Lymphoma, Large B-Cell, Diffuse/immunology
- Lymphoma, Large B-Cell, Diffuse/metabolism
- Lymphoma, Large B-Cell, Diffuse/microbiology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Signal Transduction/genetics
- Signal Transduction/immunology
- Stomach Neoplasms/genetics
- Stomach Neoplasms/immunology
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/mortality
- Stomach Neoplasms/therapy
- T-Lymphocytes/immunology
- T-Lymphocytes/metabolism
- Tumor Suppressor Protein p53/genetics
- Tumor Suppressor Protein p53/immunology
- Tumor Suppressor Protein p53/metabolism
- bcl-X Protein/genetics
- bcl-X Protein/immunology
- bcl-X Protein/metabolism
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Abstract
Abstract
Indolent B-cell lymphomas that are supposed to derive from the marginal zone (marginal zone lymphomas [MZLs]) include 3 specific entities: extranodal marginal zone lymphoma (EMZL) or mucosa-associated lymphatic tissue (MALT) lymphoma, splenic MZL (SMZL), and nodal MZL (NMZL). The clinical and molecular characteristics are different for each entity, with some shared phenotypic and genetic features. EMZL is the most common entity, accounting for approximately 70% of all MZLs. These neoplasms can arise at virtually any extranodal site and are commonly associated with chronic antigenic stimulation either as a result of infection (eg, Helicobacter pylori in the stomach) or autoimmune disease (eg, Sjögren syndrome and salivary glands). Several chromosomal translocations were also identified in EMZL, accounting in the aggregate for approximately one-third of all cases. SMZL accounts for approximately 20% of all MZLs. Patients typically present with an enlarged spleen and involvement of abdominal lymph nodes and BM. Approximately 40%-50% of SMZLs are associated with deletions of chromosome 7q. NMZL is the less common entity, representing approximately 10% of all MZLs. Patients with NMZL, by definition, have lymph node–based disease without involvement of the spleen or extranodal sites. The molecular pathogenesis of NMZL is still unknown.
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15
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Kobayashi Y, Hatta Y, Hojo A, Kura Y, Uchino Y, Takahashi H, Kiso S, Hirabayashi Y, Yagi M, Kodaira H, Kurita D, Tanaka T, Miura K, Iriyama N, Kobayashi S, Sawada U, Sugitani M, Takeuchi J. Long-term follow-up of localized, primary gastric diffuse large B-cell lymphoma treated with rituximab and CHOP. Exp Ther Med 2012; 3:304-308. [PMID: 22969886 DOI: 10.3892/etm.2011.387] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2011] [Accepted: 11/10/2011] [Indexed: 01/08/2023] Open
Abstract
The addition of rituximab to cyclophosphamide, doxorubicin, vincristine and prednisone [CHOP (i.e., R-CHOP)] is considered to be the standard regimen for treating localized, primary gastric diffuse large B-cell lymphoma (PG-DLBCL). However, few studies have reported the long-term efficacy of R-CHOP therapy in the management of localized PG-DLBCL. In the present study, we performed a retrospective analysis of 11 patients with localized PG-DLBCL, who were treated with R-CHOP at Nihon University Itabashi Hospital and Kasukabe Municipal Hospital (Japan) from 2001 to 2008. Limited stage cancer was defined as stage I/II according to the Lugano staging system for gastrointestinal (GI) lymphomas. The relative dose intensity (RDI) of CHOP therapy was calculated for each patient. The median age of the patients was 68 years (range, 48-82). Gastralgia and anemia were common symptoms at initial presentation. All patients except 1 received 6 cycles of R-CHOP treatment without consolidative radiation therapy or prior surgery. RDI was maintained at over 80% in 9 out of 11 patients. All patients achieved complete remission and the estimated overall survival with a median follow-up of 54 months (range, 39-103) was 100%, without relapse or significant GI adverse effects, such as perforation or bleeding during R-CHOP treatment. No long-term adverse effects of rituximab were recorded during the observation period. Helicobacter pylori infection was diagnosed in 72.7% (8 cases) of the patients, but was eradicated in a limited number of patients. Our data suggest the feasibility and effectiveness of the addition of rituximab to conventional CHOP therapy in the management of localized PG-DLBCL.
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16
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Sohn BS, Kim SM, Yoon DH, Kim S, Lee DH, Kim JH, Lee SW, Huh J, Suh C. The comparison between CHOP and R-CHOP in primary gastric diffuse large B cell lymphoma. Ann Hematol 2012; 91:1731-9. [PMID: 22752193 DOI: 10.1007/s00277-012-1512-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2012] [Accepted: 06/11/2012] [Indexed: 12/27/2022]
Abstract
The combination chemotherapy with cyclophosphamide, doxorubicin, vincristine, and prednisolone (CHOP) plus rituximab is the standard treatment for patients with primary gastric diffuse large B cell lymphoma (DLBCL). However, a few trials comparing CHOP plus rituximab (R-CHOP) with CHOP have been conducted in primary gastric DLBCL. Among 93 consecutive patients receiving CHOP or R-CHOP as a first-line chemotherapy at our institution, 38 patients received CHOP and 55 patients received R-CHOP. With a median follow-up time of 48 months, the complete response (CR) rate, event-free survival (EFS), and overall survival (OS) did not differ between two treatment groups (P = 1.000, P = 0.744, and P = 0.213, respectively). The CR rates were 93.9% for patients receiving CHOP and 92.5% for patients receiving R-CHOP. The 3-year EFS rates were 86.0% for patients receiving CHOP and 81.7% for patients receiving R-CHOP; the 3-year OS rates were 94.7 and 84.7%, respectively. In a multivariate analysis, The CR rate was affected by the number of extranodal involvements (P = 0.011). The EFS and OS rates were affected by the Lugano stage (P = 0.067 and P = 0.008, respectively). High serum level of β₂-microglobulin was associated with worse EFS and OS in patients receiving R-CHOP (P = 0.018 and P = 0.015, respectively). In conclusion, the addition of rituximab was not found to have an impact on patients' outcomes with primary gastric DLBCL. The β₂-microglobulin in primary gastric DLBCL might be able to discriminate the patients' prognosis who are treated with R-CHOP chemotherapy.
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Affiliation(s)
- Byeong Seok Sohn
- Department of Oncology, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 138-736, Korea
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17
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Zhang J, Li G, Yang H, Liu X, Cao J. Rituximab in treatment of primary gastric diffuse large B-cell lymphoma. Leuk Lymphoma 2012; 53:2175-81. [DOI: 10.3109/10428194.2012.680451] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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18
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Gisbert JP, Calvet X. Review article: common misconceptions in the management of Helicobacter pylori-associated gastric MALT-lymphoma. Aliment Pharmacol Ther 2011; 34:1047-62. [PMID: 21919927 DOI: 10.1111/j.1365-2036.2011.04839.x] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
BACKGROUND Helicobacter pylori infection is the main cause of gastric mucosa-associated lymphoid tissue (MALT) lymphoma. AIM To review several common misconceptions in the management of H. pylori-associated gastric MALT-lymphoma. METHODS Bibliographical searches were performed in MEDLINE up to June 2011. RESULTS If adequate diagnostic methods are used, and if only low-grade lymphomas are considered, the prevalence of H. pylori infection is very high (almost 90%). H. pylori eradication is effective in treating approximately 80% of patients with early stage lymphoma. In H. pylori-positive gastric high-grade lymphomas, antibiotic therapy should always be prescribed, as approximately 50% of them regress after H. pylori eradication. Patients with early stage MALT lymphoma negative for H. pylori might still benefit from antibiotic treatment as the sole treatment. Complete remission of gastric MALT lymphoma after H. pylori eradication can take even >12 months. PCR assay for the detection of monoclonal B cells remains positive in many cases after complete remission has been reached. Patients with a persistent clonal band should not be treated unless the lymphoma can be histologically demonstrated. Synchronous occurrence of gastric adenocarcinoma and MALT lymphoma has been repeatedly reported. In some patients in complete remission, eradication of H. pylori does not prevent later development of early gastric cancer. Gastric lymphoma recurrence occurs in some patients after both bacterial and lymphoma regression. H. pylori reinfection does not constitute a prerequisite for lymphoma recurrence. CONCLUSIONS The present article states several misconceptions in the management of H. pylori-associated gastric MALT-lymphoma in clinical practice, reviews the related scientific evidence and proposes the adequate attitude in each case.
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Affiliation(s)
- J P Gisbert
- Gastroenterology Unit, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Madrid, Spain.
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Liu FF, Ge JH, Liu HM, He J, Yuan ZG, Wang LZ, Ma XM. Clinical significance of nuclear factor κB expression in primary gastrointestinal diffuse large B-cell lymphoma. Shijie Huaren Xiaohua Zazhi 2011; 19:1476-1482. [DOI: 10.11569/wcjd.v19.i14.1476] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To investigate the clinical significance of nuclear factor κB (NF-κB) expression in primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL).
METHODS: Immunohistochemical staining was used to detect the expression of CD10, Bcl-6, Mum-1 and NF-κB p65 in PGI-DLBCL. The relationship of NF-κB p65 expression with tumor subtype, biological behavior and prognosis was analyzed.
RESULTS: Of 54 cases of PGI-DLBCL detected, 28% were positive for CD10, 69% positive for Bcl-6, and 81% positive for Mum-1; 19 were classified as germinal center B-cell-like (GCB) subtype, and 35 as activated B-cell like (ABC) subtype. The positive rate of NF-κB p65 expression in PGI-DLBCL was 72% (39/54). The positive rate of NF-κB p65 expression was significantly higher in ABC-DLBCL than in GCB-DLBCL (74.4% vs 25.6%, P < 0.05). NF-κB p65 expression was correlated with extranodal invasion site in PGI-DLBCL (P < 0.05). The overall survival time of NF-κB p65-negative PGI-DLBCL patients was longer than that of NF-κB p65-positive ones (45.8 mo ± 35.9 mo vs 20.3 mo ± 29.3 mo, P < 0.05).
CONCLUSION: NF-κB p65 expression was positively correlated with the subtype, development, and invasion of PGI-DLBCL. NF-κB p65 can be used as a prognostic factor for PGI-DLBCL and may represent a new molecular target for the therapy of GI-DLBCL.
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Goda JS, Gospodarowicz M, Pintilie M, Wells W, Hodgson DC, Sun A, Crump M, Tsang RW. Long-term outcome in localized extranodal mucosa-associated lymphoid tissue lymphomas treated with radiotherapy. Cancer 2010; 116:3815-24. [PMID: 20564130 DOI: 10.1002/cncr.25226] [Citation(s) in RCA: 145] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND This study was conducted to evaluate the long-term outcomes in patients with stage IE and IIE mucosa-associated lymphoid tissue (MALT) lymphomas treated with involved field radiotherapy (RT). METHODS Between 1989 and 2004, 192 patients with stage I and II MALT lymphomas were treated. The report focuses on 167 patients who received RT. The median age of patients was 58 years with a female predominance (2:1). Presenting sites were as follows: orbital adnexa in 71 patients, salivary glands in 28 patients, stomach in 25 patients, thyroid in 21 patients, and other sites in 22 patients. The median dose to nonorbital sites was 30 grays (Gy) (range, 17.5-35 Gy) and was 25 Gy for the orbit (range, 25-35 Gy). The median follow-up was 7.4 years (range, 0.67-16.20 years). RESULTS Complete response and complete response, unconfirmed (CR/CRu) was noted in 166 (99%) patients. The 10-year recurrence-free rate (RFR) was 76%, the disease-free survival (DFS) rate was 68%, the overall survival (OS) rate was 87%, and the cause-specific survival rate was 98%. According to presenting site, the 10-year RFR was 95% for thyroid, 92% for stomach, 68% for salivary glands, and 67% for orbit. Patients with thyroid and gastric MALTs had better outcome compared with patients with MALTs diagnosed at other sites (P=.004). Among those patients who achieved CR, 19% developed disease recurrence (n=31), chiefly in distant sites or untreated contralateral-paired organs. At the time of disease recurrence, 7 patients (23%) had transformed to diffuse large B-cell lymphoma, 2 of whom died of lymphoma. The 5-year OS rate after treatment failure was 83%. CONCLUSIONS Patients with localized MALT lymphomas are reported to have excellent clinical outcome after moderate-dose RT, and some are likely cured. In the current study, thyroid and gastric MALTs were found to have significantly less risk of distant recurrence. Despite disease recurrence, the overall survival remains excellent in these patients.
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Affiliation(s)
- Jayant S Goda
- Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto, Ontario, Canada
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21
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Leopardo D, Lorenzo GD, Renzo AD, Federico P, Luponio S, Buonerba C, Matano E, Merola G, Imbimbo M, Montesarchio E, Rea A, Merola MC, Placido SD, Palmieri G. Efficacy of rituximab in gastric diffuse large B cell lymphoma patients. World J Gastroenterol 2010; 16:2526-30. [PMID: 20503452 PMCID: PMC2877182 DOI: 10.3748/wjg.v16.i20.2526] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To evaluate retrospectively the efficacy of rituximab plus chemotherapy in gastric diffuse large B cell lymphoma (DLBCL).
METHODS: Sixty patients (median age: 58 years) with histologically confirmed gastric DLBCL treated at four Italian institutions between 2000 and 2007, were included in this analysis. Patients were selected by stage (I-IV, Lugano staging system), European Cooperative Oncology Group performance status (0-2) and treatment strategies. Treatment strategies were chemotherapy alone (group A, n = 30) [scheduled as cyclophosphamide, doxorubicin, vincristine and prednisone (CHOP) and CHOP-like], and chemotherapy combined with rituximab (group B, n = 30). The primary end point of the study was complete response (CR) rate; the secondary end points were disease-free survival (DFS) at 5 years and overall survival (OS).
RESULTS: Median follow-up was 62 mo (range: 31-102 mo). We observed a significant difference between the two groups (A vs B) in terms of CR [76.6% (23/30) vs 100%, P = 0.04) and DFS at 5 years [73.3% (22/30) vs 100%, P = 0.03). To date, 19 group A (63.3%) patients are alive and 11 have died, while all group B patients are alive. No significant differences in toxicity were observed between the two groups.
CONCLUSION: Rituximab in combination with chemotherapy improves CR rate, DFS and OS. Further prospective trials are needed to confirm our results.
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Chihara D, Oki Y, Ine S, Kato H, Onoda H, Taji H, Kagami Y, Yamamoto K, Morishima Y. Primary gastric diffuse large B-cell Lymphoma (DLBCL): analyses of prognostic factors and value of pretreatment FDG-PET scan. Eur J Haematol 2010; 84:493-8. [PMID: 20148943 DOI: 10.1111/j.1600-0609.2010.01426.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES We report a single institution experience with gastric diffuse large B-cell lymphoma (DLBCL) in an attempt to evaluate the roles of different treatment modalities, to assess the value of pretreatment positron emission tomography (PET) scan, and to identify potential prognostic factors. METHODS Among 384 patients diagnosed with DLBCL between 1995 and 2008, 75 patients had primary gastric DLBCL and were reviewed and analyzed. RESULTS The median age was 66. International prognostic index (IPI) risk was low in 52%, low-intermediate in 23%, high-intermediate in 9%, and high in 16%. Pretreatment PET scan was highly sensitive in detecting gastric lesions except stage I gastric DLBCL without detectable mass by CT or gastroscopy. As a general rule, patients with limited-stage disease were treated with three times of CHOP (with or without rituximab) and radiotherapy, and those with advanced-stage disease were treated with eight cycles of CHOP (with or without rituximab), and radiotherapy was given to residual diseases after chemotherapy. Three-year overall survival (OS) rate was 78%. Multivariate analysis revealed that low albumin, hemoglobin <12.0 g/dL, and treatment without rituximab were independently associated with shorter OS. Low albumin, hemoglobin <12.0 g/dL,and advanced stage were independently associated with shorter progression-free survival. CONCLUSION We showed the survival benefit of rituximab and potential prognostic value of pretreatment hemoglobin and serum albumin levels in gastric DLBCL.
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Affiliation(s)
- Dai Chihara
- Department of Hematology and Cell Therapy, Aichi Cancer Center Hospital, Nagoya, Japan
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Raderer M, Paul de Boer J. Role of chemotherapy in gastric MALT lymphoma, diffuse large B-cell lymphoma and other lymphomas. Best Pract Res Clin Gastroenterol 2010; 24:19-26. [PMID: 20206105 DOI: 10.1016/j.bpg.2009.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2009] [Revised: 11/18/2009] [Accepted: 11/25/2009] [Indexed: 01/31/2023]
Abstract
Primary gastrointestinal lymphomas are relatively common, with the large majority occurring in the stomach. In the commonest histological subtype, i.e. diffuse large B-cell lymphoma (DLCBL), chemotherapy has widely been applied in the past, either following surgery or - in more recent years - as part of conservative management in combination with radiotherapy. Relatively little data, however, exist for chemotherapy as sole treatment modality in localised gastric DLBCL, which nevertheless are highly promising and suggest that combination therapy might overtreat a substantial proportion of patients. In gastric MALT-lymphoma, the use of chemotherapy has been restricted either to patients with a priori disseminated disease or individuals judged to be at high risk or failing local treatment approaches. Only a few prospective phase II studies have been performed, and one controlled trial has shown that chemotherapy was superior in terms of event free survival at ten years when compared to radiation and surgery. These suggest that systemic treatment approaches might be highly effective both in gastric DLBCL as well as MALT-lymphoma, and the scope of this article is to briefly summarize current data on chemotherapy in gastric and GI-lymphomas according to histologic subtypes.
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Affiliation(s)
- Markus Raderer
- Department of Internal Medicine I, Medical University Vienna, Austria.
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Avilés A, Castañeda C, Cleto S, Neri N, Huerta-Guzmán J, Gonzalez M, Nambo MJ. Rituximab and chemotherapy in primary gastric lymphoma. Cancer Biother Radiopharm 2009; 24:25-8. [PMID: 19216628 DOI: 10.1089/cbr.2008.0507] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE We performed a phase II clinical trial to assess the efficacy and toxicity of the addition of rituximab and conventional chemotherapy in primary gastric lymphoma (PGL). METHODS Forty-two (42) patients with PGL, stage IE and IIE, and with low- or low-intermediate clinical risk were treated in a prospective longitudinal study with standard CHOP (cyclophosphamide, doxorubicin, vincristine, and prednisone) chemotherapy and rituximab (375 mg/m2, intravenously) on day 1 of each cycle administered every 21 days, for 6 cycles. The endpoint was to assess improvement in outcome measured by prolongation in event-free survival (EFS) and overall survival (OS). Complete response was achieved in 40 cases (95%) (95% confidence interval [CI]: 88%-102%). Relapse was observed in 2 cases. Two (2) patients died secondary to tumor progression. Thus, actuarial 5-year EFS was 95% (95 % CI: 87%-104%) and OS was 95% (95% CI: 88%-101%), which was not statistically different to historic controls. Acute toxicity was minimal and well tolerated, 4 cases developed late toxicity, 2 cases of herpes zoster infection, and 2 cases with granulocytopenia; in 1 case, the patient continued with mild granulocytopenia 3 years after treatment. CONCLUSIONS The addition of rituximab to CHOP chemotherapy did not improve outcome in early-stage PGL.
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Affiliation(s)
- Agustin Avilés
- Oncology Research Unit, Oncology Hospital, National Medical Center, Plaza Luis Cabrera 5-502, Colonia Roma, Mexico.
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Ben Salah H, Ghorbel L, Krichen MS, Bellaaj H, Elloumi M, Frikha M, Daoud J. [The value of radiotherapy in the treatment of aggressive and localised gastric lymphomas]. Cancer Radiother 2008; 13:11-6. [PMID: 19091618 DOI: 10.1016/j.canrad.2008.11.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2008] [Revised: 11/03/2008] [Accepted: 11/04/2008] [Indexed: 12/01/2022]
Abstract
PURPOSE To evaluate the treatment results of localised aggressive gastric lymphomas with favourable prognosis using chemotherapy and radiotherapy. PATIENTS AND METHODS Between February 1993 and December 2004, nine patients with primary gastric high-grade lymphoma have been treated by the Lymphoma Committee of Sfax (Tunisia). The sex ratio was 1.5. The mean age was 44.9 years. Histological type was the large cell B lymphoma in 100% of the cases. Disease was stage I in eight cases and stage II in one case (Ann Arbor Classification). The treatment consisted in primary chemotherapy followed by radiotherapy of the stomach with or without regional nodes (40 Gy). RESULTS After treatment, all patients had complete remission. With a mean follow-up of 55.7 months, one patient was lost to follow-up; the other patients were alive with complete remission. No major acute toxicities or late effects were found. Overall survival was 100% at five years. CONCLUSION Chemotherapy associated with radiotherapy can be proposed to patients having localised and aggressive primary gastric lymphoma with favourable prognosis, since this treatment is well tolerated and provides satisfactory control of the disease.
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Affiliation(s)
- H Ben Salah
- Service de radiothérapie carcinologique, CHU Habib-Bourguiba, rue Majida-Bouleïla, 3029 Sfax, Tunisie.
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Psyrri A, Papageorgiou S, Economopoulos T. Primary extranodal lymphomas of stomach: clinical presentation, diagnostic pitfalls and management. Ann Oncol 2008; 19:1992-9. [PMID: 18647965 DOI: 10.1093/annonc/mdn525] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
Gastrointestinal lymphoma is the most common form of extranodal lymphoma, accounting for 30%-40% of cases. The most commonly involved site is the stomach (60%-75% of cases), followed by the small bowel, ileum, cecum, colon and rectum. The most common histological subtypes are diffuse large B-cell lymphoma (DLBCL) and marginal zone B-cell lymphoma of the mucosa-associated lymphoid tissue (MALT). Helicobacter pylori infection has been implicated in the pathogenesis of MALT gastric lymphoma, but its role in gastric diffuse large B-cell non-Hodgkin's lymphoma (NHL) is controversial. The therapeutic approach for patients with gastric NHL has been revised over the last 10 years. Conservative treatment with anthracycline-based chemotherapy alone or in combination with involved-field radiotherapy has replaced gastrectomy as standard therapy in cases with DLBCL. Additionally, MALT lymphomas are mainly treated with antibiotics alone, which can induce lasting remissions in those cases associated with H. pylori infection. Nevertheless, various therapeutic aspects for primary gastric lymphomas are still controversial and several questions remain unanswered. Among others, the role of rituximab, consolidation radiotherapy as well as H. pylori eradication in histological aggressive subtypes warrants better clarification.
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Affiliation(s)
- A Psyrri
- Second Department of Internal Medicine Propaedeutic, Athens University Medical School, University General Hospital Attikon, Haidari, Greece
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Medina-Franco H, Germes SS, Maldonado CL. Prognostic factors in primary gastric lymphoma. Ann Surg Oncol 2007; 14:2239-45. [PMID: 17546474 DOI: 10.1245/s10434-006-9244-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2006] [Revised: 09/11/2006] [Accepted: 09/18/2006] [Indexed: 12/20/2022]
Abstract
BACKGROUND There is not a gold standard in the treatment of primary gastric lymphoma (PGL). This study aimed to establish prognostic factors that should be considered for the staging and management of this disease. METHODS We retrospectively reviewed and analyzed the clinicopathological features of patients treated for PGL in a tertiary referral center in Mexico City in a 10-year period from 1990 through 2000. Staging was performed with the Ann-Arbor system. Overall and disease-free survivals were the primary endpoints. RESULTS We identified 41 patients of which 19 (46.3%) were classified as large-cell lymphoma, 16 (39.0%) as low-grade MALT, and 6 (14.6%) patients as lymphoma unspecified. The series included 15 (36.6%) patients with stage IV disease. Twenty patients (48.8%) underwent surgery and 34 (82.1%) received chemotherapy. Twenty-three patients were treated with at least two different types of therapy (56.1%). Actuarial 1 and 5 years survival were 77.8 and 71.2%, respectively. Early stage at presentation, surgery, normal lactic dehydrogenase (LDH) levels and good performance status were associated with longer survival in univariate analysis. Only normal LDH and good performance status retained their significance in multivariate analysis. Regarding disease-free survival in multivariate analysis, only normal LDH was associated with a better prognosis: 131 versus 12 months for LDH <197 and >or=197 mg/dl, respectively (P < 0.0001). CONCLUSIONS Optimal treatment of PGL remains controversial. High LDH levels and poor performance status at diagnosis are associated with shorter overall and disease-free survival and should be considered for the staging and management of these patients.
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MESH Headings
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Combined Modality Therapy
- Cyclophosphamide/therapeutic use
- Disease-Free Survival
- Doxorubicin/therapeutic use
- Female
- Follow-Up Studies
- Gastrectomy
- Humans
- L-Lactate Dehydrogenase/blood
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/radiotherapy
- Lymphoma, B-Cell, Marginal Zone/surgery
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Prednisone/therapeutic use
- Prognosis
- Retrospective Studies
- Stomach Neoplasms/blood
- Stomach Neoplasms/mortality
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Survival Rate
- Time Factors
- Treatment Outcome
- Vincristine/therapeutic use
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Affiliation(s)
- Heriberto Medina-Franco
- Department of Surgery, Division of Surgical Oncology, National Institute of Medical Sciences and Nutrition Salvador Zubiran, Vasco de Quiroga 15, Tlalpan, Mexico City, 14000, Mexico.
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Ferreri AJM, Montalbán C. Primary diffuse large B-cell lymphoma of the stomach. Crit Rev Oncol Hematol 2007; 63:65-71. [PMID: 17339119 DOI: 10.1016/j.critrevonc.2007.01.003] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2006] [Revised: 01/17/2007] [Accepted: 01/17/2007] [Indexed: 01/08/2023] Open
Abstract
The stomach is the extranodal site most commonly involved by non-Hodgkin lymphomas. Diffuse large B-cell lymphoma is the most common histotype category arising in this organ. This is an aggressive lymphoma usually presenting as limited disease, being associated or not to Helicobacter pylori infection and mucosa-associated lymphoid tissue-type areas. Histopathological characteristics are similar to those reported for other diffuse large B-cell lymphomas. It occurs more frequently in males with a median age ranging between 50 and 60 years. With an adequate therapeutic strategy, its prognosis is good, with a 5-year overall survival near to 90%. Conservative treatment with anthracycline-containing chemotherapy, followed or not by involved-field radiotherapy has replaced gastrectomy as standard approach against this malignancy. Several questions on the best treatment remain unanswered. Among others, the role of rituximab, consolidation radiotherapy as well as of more conservative approaches like H. pylori-eradicating antibiotic therapy should be better defined.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal/therapeutic use
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Agents/administration & dosage
- Antineoplastic Agents/therapeutic use
- Female
- Helicobacter Infections/complications
- Helicobacter Infections/drug therapy
- Helicobacter pylori/pathogenicity
- Humans
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Rituximab
- Sex Factors
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/pathology
- Stomach Neoplasms/radiotherapy
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Dickson BC, Serra S, Chetty R. Primary gastrointestinal tract lymphoma: diagnosis and management of common neoplasms. Expert Rev Anticancer Ther 2007; 6:1609-28. [PMID: 17134365 DOI: 10.1586/14737140.6.11.1609] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Primary gastrointestinal lymphoma represents the most common location of extranodal lymphoma. With the bulk of disease manifesting within the gastrointestinal tract and contiguous lymph nodes, many of the lymphomas occurring in the peripheral lymph nodes can also present with primary gastrointestinal tract involvement. Molecular biology has recently enabled significant progress in the diagnosis and management of primary gastrointestinal lymphoma. Herein, we will discuss the major lymphomas affecting the bowel and highlight their key morphological, immunophenotypical and molecular diagnostic attributes. Similarly, in keeping with recent therapeutic advances, we will briefly discuss some important treatment considerations. Thus, this review is intended to offer clinicians and pathologists an overview of primary gastrointestinal lymphomas.
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Affiliation(s)
- Brendan C Dickson
- University of Toronto, Department of Laboratory Medicine and Pathobiology, Toronto General Hospital, Department of Pathology, 200 Elizabeth Street, 11th Floor, Residents and Fellows Room, Toronto, Ontario, Canada.
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Ferrucci PF, Zucca E. Primary gastric lymphoma pathogenesis and treatment: what has changed over the past 10 years? Br J Haematol 2006; 136:521-38. [PMID: 17156403 DOI: 10.1111/j.1365-2141.2006.06444.x] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Primary gastric (PG) lymphomas are generally non-Hodgkin lymphomas (NHL). They represent 5% of gastric malignancies and show an apparently increasing incidence worldwide. The most common histological subtypes are diffuse large B-cell and marginal zone B-cell NHL of the mucosa-associated lymphoid tissue (MALT)-type. Pathogenesis is often related to Helicobacter pylori infection (HPI). There is still no consensus on the optimal treatment for PG lymphoma. Nowadays surgery is limited to rare cases and radiotherapy--combined or not with chemotherapy--represents an effective therapeutic option ensuring long-term, organ-salvage benefits mainly in aggressive histological subtypes. Additionally, the description of MALT lymphomas has made the situation even more complex, because antibiotics alone can induce lasting remissions in those cases associated with HPI. Consequently, a global therapeutic approach to the cure of PG-NHL has completely changed over the last 10 years: innovative, conservative options to reduce treatment toxicity, thus preventing systemic relapses, have made their appearance and are on the rise.
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MESH Headings
- Helicobacter Infections/complications
- Helicobacter pylori
- Humans
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/etiology
- Lymphoma, B-Cell/therapy
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/etiology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Non-Hodgkin/diagnosis
- Lymphoma, Non-Hodgkin/etiology
- Lymphoma, Non-Hodgkin/therapy
- Stomach Neoplasms/diagnosis
- Stomach Neoplasms/etiology
- Stomach Neoplasms/therapy
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Park YH, Kim WS, Bang SM, Lee SI, Uhm JE, Yang SH, Lee SS, Park K, Ko YH, Ryoo BY. What is stage II in high-grade primary gastric lymphoma? How to define the range of "localized disease". Leuk Res 2006; 31:1039-43. [PMID: 17027954 DOI: 10.1016/j.leukres.2006.08.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2006] [Revised: 08/07/2006] [Accepted: 08/26/2006] [Indexed: 10/24/2022]
Abstract
We conducted a retrospective analysis to evaluate the Musshoff staging system for high-grade primary gastric lymphoma (HG-PGL), particularly in those patients with stages IE and IIE localized diseases. One hundred twenty-six patients presented with stage IE or IIE diseases were retrospectively reclassified on the basis of a pretreatment CT examination as to whether there was lymph node involvement. A positive M1 node (by AJCC staging system) on pretreatment CT scanning was associated with poor clinical outcome for localized stage I or II patients.
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Affiliation(s)
- Yeon Hee Park
- Department of Hematology-Oncology, Korea Institute of Radiological & Medical Sciences, Seoul, Republic of Korea
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Spectre G, Libster D, Grisariu S, Da'as N, Yehuda DB, Gimmon Z, Paltiel O. Bleeding, Obstruction, and Perforation in a Series of Patients With Aggressive Gastric Lymphoma Treated With Primary Chemotherapy. Ann Surg Oncol 2006; 13:1372-8. [PMID: 17009162 DOI: 10.1245/s10434-006-9069-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Revised: 06/27/2006] [Accepted: 06/28/2006] [Indexed: 11/18/2022]
Abstract
BACKGROUND The management of patients with gastric lymphoma has evolved, with a shift toward nonsurgical treatment. The rates of surgical complications in patients receiving chemotherapy have been insufficiently studied. The objective of this study was to assess the frequency of bleeding, perforation, and gastric outlet obstruction in patients who received chemotherapy as primary treatment for gastric diffuse large B cell lymphoma (DLBCL). METHODS We reviewed files of all patients with gastric DLBCL who were diagnosed and treated primarily with chemotherapy in our hospital between 1990 and 2005. RESULTS Eighteen (25%) of 73 patients experienced surgical complications, of whom 6 (8%) underwent surgery. Eight patients (11%), six with active lymphoma, experienced gastric bleeding; one required gastrectomy. Eight patients (11%) developed gastric outlet obstruction, of whom three were treated conservatively, three required surgery, one stopped treatment, and one received further chemotherapy. Six of the eight patients had no evidence of active lymphoma at the time of obstruction. Two additional patients underwent gastrectomy due to resistant or relapsed disease. Gastric perforation was not observed. Median survival was 90 months for the entire series, 94 months for patients with gastric outlet obstruction, and 11.5 months for patients with gastric bleeding. CONCLUSIONS Given the rate of surgical complications, especially gastric bleeding and gastric outlet obstruction, there is still an important role for the surgical consultant in the treatment of patients with gastric DLBCL receiving chemotherapy. Gastric perforation, although frequently cited as a complication, is in fact rarely observed.
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Affiliation(s)
- Galia Spectre
- Department of Hematology, Hadassah Hebrew University Medical Center, Jerusalem, Israel 91120.
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Montalban C, Norman F. Treatment of gastric mucosa-associated lymphoid tissue lymphoma: Helicobacter pylori eradication and beyond. Expert Rev Anticancer Ther 2006; 6:361-71. [PMID: 16503853 DOI: 10.1586/14737140.6.3.361] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma is the paradigm of lymphomas developing in extranodal areas after antigen stimulation. In the stomach, Helicobacter pylori colonization induces the appearance of MALT and, eventually, MALT-derived lymphoma. This type of lymphoma is initially a localized form of disease, but may disseminate and transform into high-grade lymphoma, making full staging (as for nodal lymphomas) and endoscopic ultrasonography to evaluate the penetration of the lymphoma through the gastric wall mandatory. In localized gastric MALT lymphoma, the first step in treatment is eradication of H. pylori, which results in 60-90% regression. This response is maintained for years in most patients, with only 10-15% relapse, frequently precipitated by H. pylori reinfection. A component of high-grade lymphoma, penetration to gastric serosa or beyond and translocation t(11;18) are the main factors that make lymphoma resistant to eradication. Surgery or radiotherapy can cure localized lymphomas in 75-90% of patients. Chemotherapy with alkylating agents, combination chemotherapy and purine analogs, and anti-CD20 antibodies can also induce remission of localized lymphomas refractory to eradication, as well as locally advanced and disseminated lymphomas. The optimum chemotherapy treatment for advanced disease has not yet been established; however, combination therapy, including purine analogs with or without anti-CD20, may be a promising option. Despite histological responses and prolonged remissions, residual molecular disease can be demonstrated in most cases treated with H. pylori eradication, radiotherapy or alkylating agents, and even after more intense chemotherapy, although this does not seem to lead to late relapses. High-grade gastric MALT lymphoma should be treated with chemotherapy, with cyclophosphamide, doxorubicin, oncovin and prednisone being the best first-line option. All gastric MALT lymphomas associated with H. pylori should receive eradication treatment in addition to other required treatment.
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Affiliation(s)
- Carlos Montalban
- Department of Internal Medicine, Hospital Ramon y Cajal, Universidad de Alcalá de Henares, Madrid, 28034, Spain.
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35
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Park YH, Kim WS, Bang SM, Lee SI, Kang HJ, Na II, Yang SH, Lee SS, Uhm JE, Kwon JM, Kim K, Jung CW, Park K, Ko YH, Ryoo BY. Primary gastric lymphoma of T-cell origin: clinicopathologic features and treatment outcome. Leuk Res 2006; 30:1253-8. [PMID: 16529813 DOI: 10.1016/j.leukres.2006.01.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Revised: 12/27/2005] [Accepted: 01/26/2006] [Indexed: 12/19/2022]
Abstract
We conducted a retrospective analysis to investigate the natural history and the clinical outcome after treatment of primary gastric lymphoma of T-cell origin. Seventeen cases of T-cell origin among 444 primary gastric lymphoma patients were analyzed. The median age of the 14 male and 3 female patients was 49 years (range 22-76 years). The median progression-free survival (PFS) and overall survival (OS) were only 10 months (95% CI; 0-20 months), and 12 months (95% CI; 4-21 months), respectively. This study showed that the incidence of this subtype of T-cell gastric lymphoma was very rare, and had poor prognosis.
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Affiliation(s)
- Yeon Hee Park
- Department of Hematology-Oncology, Korea Institute of Radiological & Medical Sciences, Nowon-ku, Seoul, Republic of Korea.
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Wöhrer S, Bartsch R, Hejna M, Drach J, Raderer M. Routine application of the proton-pump inhibitor pantoprazole in patients with gastric lymphoma undergoing chemotherapy. Scand J Gastroenterol 2005; 40:1222-5. [PMID: 16265779 DOI: 10.1080/00365520510023440] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The stomach is the most common site of origin for extranodal lymphomas. While resection has played a major part in the management of such patients in the past, in recent years there has been a change towards organ-conserving therapies. However, the risk of perforation and bleeding in patients undergoing organ-conserving therapy has been used as an argument against primary application of chemotherapy. In this article, we present our experience with the prophylactic use of oral pantoprazole. MATERIAL AND METHODS All patients undergoing chemotherapy for gastric lymphoma at our institution were prophylactically given oral pantoprazole (2x40 mg) for the duration of chemotherapy. Compliance with intake of the proton-pump inhibitor (PPI) was assessed at every visit for application of chemotherapy and at routine blood counts taken 10-14 days after each cycle of treatment by direct questioning of the patient. RESULTS A total of 82 patients (median age 69 years, range 33-93) received chemotherapy for gastric lymphoma: 51 had diffuse large B-cell lymphoma (DLBCL), 24 had mucosa-associated lymphoid tissue (MALT) lymphoma and 7 had DLBCL+MALT lymphoma. Compliance with intake of the PPI was excellent, as only two patients reported irregular intake and only one patient refused regular medication with pantoprazople. All patients responded to chemotherapy, with 74 (90%) achieving complete remission and 8 (10%) partial remission. After a median follow-up time of 50 months (range: 9-84 months) only one of these 82 patients (1.22%), the patient who discontinued intake of pantoprazole, died from gastric perforation, while none of the other patients had gastrointestinal bleeding or perforation. CONCLUSIONS Judging from these data, continuous PPI intake is feasible and has a high rate of compliance. In the absence of randomized trials, routine application of oral pantoprazole in patients given chemotherapy for gastric lymphoma, especially DLBCL, appears to be a reasonable approach.
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MESH Headings
- 2-Pyridinylmethylsulfinylbenzimidazoles
- Administration, Oral
- Adult
- Aged
- Aged, 80 and over
- Anti-Ulcer Agents/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Benzimidazoles/therapeutic use
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Follow-Up Studies
- Humans
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/pathology
- Middle Aged
- Mitoxantrone/administration & dosage
- Neoplasm Staging
- Omeprazole/analogs & derivatives
- Omeprazole/therapeutic use
- Pantoprazole
- Patient Compliance
- Prednisone/administration & dosage
- Proton Pump Inhibitors
- Rituximab
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/pathology
- Sulfoxides/therapeutic use
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- Stefan Wöhrer
- Department of Medicine I, Medical University Vienna, Austria
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Ho CL, Hsieh AT, Dai MS, Chen YC, Kao WY, Chao TY. Non-Hodgkin's lymphoma of the stomach: treatment outcomes for 57 patients over a 20-year period. J Chin Med Assoc 2005; 68:11-5. [PMID: 15742857 DOI: 10.1016/s1726-4901(09)70125-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
BACKGROUND Gastric non-Hodgkin's lymphoma (NHL) is a rare subtype of malignancy, for which no consensus exists about treatment. In this study, the treatment outcomes of gastric NHL in 57 patients were retrospectively evaluated for a period of 20 years at a single institute. METHODS Clinical stages were classified according to the Ann Arbor staging system: 29 patients were stage 1, 17 stage II, two stage III, and nine stage IV. The 46 stage I/II patients received aggressive, multimodal therapy: 24 of these (group A) were treated with surgery-based management, which included surgery alone (n = 6), surgery + chemotherapy (CT; n = 14), surgery + radiotherapy (RT; n = 2), and surgery + CT + RT (n = 2); 22 patients (group B) did not receive surgery, but received CT alone (n = 11), CT + RT (n = 5), or, in patients with low-grade mucosa-associated lymphoid tissue (MALT) lymphoma, an oral anti-Helicobacter pylori regimen (n = 6). The 11 stage III/IV patients received CT and/or RT with regimens similar to those for stage I/III patients. RESULTS Except for 1 patient with an initial surgical diagnosis, 56 patients underwent gastric endoscopic examination, which proved that 42 had NHL. The rate of diagnostic accuracy by gastroscopy was 75%. After multimodal treatment (n = 46) and a median follow-up of 54 months (range, 1-210 months), the 5-year survival rate was 40.3%. The 5-year survival rates for stage 1, II and III/IV patients were 57.2%, 47% and 0%, respectively (p < 0.005). Of the 24 surgical patients (group A) who received sequential CT, with or without RT, 12 remained disease-free after a median follow-up of 98 months (range, 1-210 months); three patients died because of postoperative complications. Of the 22 non-surgical patients (group B) who received CT, alone or combined with RT, 14 remained disease-free after a median follow-up of 40 months (range, 4-189 months); 1 patient died because of massive gastric hemorrhage after CT. All stage III and IV patients died after a median survival of 4 months (range, 1-8 months). CONCLUSION Clinical stage is the most important factor predicting the long-term survival of patients with gastric NHL. Surgery may still be necessary in cases of failed gastroscopic diagnosis. In early-stage gastric NHL, non-surgical treatment seems able to achieve the aims of improved long-term survival and, in some instances, cure.
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Affiliation(s)
- Ching-Liang Ho
- Division of Hematology/Oncology, Department of Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC.
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Wöhrer S, Püspök A, Drach J, Hejna M, Chott A, Raderer M. Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) for treatment of early-stage gastric diffuse large B-cell lymphoma. Ann Oncol 2004; 15:1086-90. [PMID: 15205203 DOI: 10.1093/annonc/mdh261] [Citation(s) in RCA: 38] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) of the stomach is a relatively common disease. Recently, chemotherapy consisting of doxorubicin, cyclophosphamide, vincristine and prednisone (CHOP) has been reported as effective treatment for early-stage gastric DLBCL. Given the fact that the application of the CD20 antibody rituximab (R) in addition to CHOP has improved outcomes in nodal DLBCL, we have analysed our experience with application of R-CHOP in patients with early-stage gastric DLBCL. PATIENTS AND METHODS Patients with histologically verified early-stage gastric DLBCL undergoing treatment with R-CHOP for initial management were analysed. RESULTS Fifteen patients received a total of 79 cycles, with a median of six cycles per patient. All patients responded to therapy, 13 had a complete remission (CR) (87%) and two (13%) a partial remission. All patients in CR, except one who died unrelated to lymphoma, have remained so with a median follow-up of 15 months (range 4-42) after treatment. Subjective tolerance was moderate, and toxicities were mainly haematological, including leukocytopenia WHO grade 3 and 4 in 10 and five patients each. The addition of rituximab to the standard CHOP regimen did not appear to significantly increase toxicity. CONCLUSIONS Our data indicate that R-CHOP is an effective regimen for management of early-stage gastric DLBCL. However, given the excellent results with CHOP alone in such patients, the value of adding rituximab to standard CHOP remains to be determined in a randomised trial.
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Affiliation(s)
- S Wöhrer
- Department of Internal Medicine I, Division of Oncology, Center of Excellence in Clinical and Experimental Oncology (CLEXO), University of Vienna, Vienna, Austria
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Abstract
The ability to make treatment recommendations for patients with gastrointestinal lymphoma is hampered by a lack of prospective trials and by a lack of uniformity in classification and staging. Patients with gastric diffuse large B-cell lymphoma have traditionally been treated with surgery and many physicians continue to recommend this approach. However, recent data suggest that these patients can be treated with combination chemotherapy regimens in the same manner as patients with nodal presentations of diffuse large B-cell lymphoma. There is evidence to suggest that adjuvant radiotherapy may improve the outcome for these patients. The recognition that extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue is a distinct clinicopathologic entity and the elucidation of the pathogenic role of Helicobacter pylori has revolutionized the treatment of these gastric lymphomas. Patients with localized disease should be managed with antibiotic therapy initially. Radiation therapy is extremely effective for these patients, but it should probably be reserved for patients who fail anti-H. pylori treatment.
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MESH Headings
- Adult
- Aged
- Chemotherapy, Adjuvant
- Combined Modality Therapy
- Digestive System Surgical Procedures/methods
- Female
- Gastrointestinal Neoplasms/mortality
- Gastrointestinal Neoplasms/pathology
- Gastrointestinal Neoplasms/therapy
- Humans
- Lymphoma, B-Cell/mortality
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell/therapy
- Lymphoma, B-Cell, Marginal Zone/mortality
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Male
- Middle Aged
- Neoplasm Staging
- Prognosis
- Risk Assessment
- Survival Analysis
- Treatment Outcome
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Affiliation(s)
- Philip J Bierman
- University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE 68198, USA.
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40
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Abstract
Despite decreasing incidence during the last 50 years, gastric cancer still ranks as one of the most frequent cancers. A multifactorial model of human gastric carcinogenesis is currently accepted in which different dietary and nondietary factors, including genetic susceptibility of the host and Helicobacter pylori infection are involved at different stages in the cancer process. On the molecular level, at least two phenotypes, associated with distinct pathways of genome destabilization, have been identified. However, applying new technologies such as cDNA microarrays a new era in the analysis of molecular markers has started. This molecular technology may open the path towards novel treatment modalities, i.e. gene therapy. Epidemiological, biological, and molecular genetic studies have also implicated the role of H. pylori in lymphomagenesis. Knowledge of pathogenesis and therapy is increasing while good epidemiological data are rare. Many studies have demonstrated that MALT-type lymphomas develop along two different pathways: t(11;18)-positive cases, and t(11;18)-negative cases. Meanwhile, a third translocation could be detected, the t(14;18), opening the discussion of a possible third pathway of lymphoma development.
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Affiliation(s)
- Gerardo Nardone
- Departments of Clinical and Experimental Medicine, University of Naples Federico II, Naples, Italy
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