1
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Fox CP, Chaganti S, McIlroy G, Barrington SF, Burton C, Cwynarski K, Eyre TA, Illidge T, Kalakonda N, Kuhnl A, McKay P, Davies AJ. The management of newly diagnosed large B-cell lymphoma: A British Society for Haematology Guideline. Br J Haematol 2024; 204:1178-1192. [PMID: 38247115 DOI: 10.1111/bjh.19273] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 11/20/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024]
Affiliation(s)
| | - Sridhar Chaganti
- Centre for Clinical Haematology, University Hospitals Birmingham, Birmingham, UK
| | - Graham McIlroy
- Institute of Cancer and Genomic Sciences, University of Birmingham, Birmingham, UK
| | - Sally F Barrington
- King's College London and Guy's and St Thomas' PET Centre, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
| | - Cathy Burton
- Department of Haematology, The Leeds Teaching Hospitals, Leeds, UK
| | - Kate Cwynarski
- Department of Haematology, University College London Hospitals, London, UK
| | - Toby A Eyre
- Oxford Cancer and Haematology Centre, Oxford University Hospitals, Oxford, UK
| | - Timothy Illidge
- Division of Cancer Sciences, Manchester NIHR Biomedical Research Centre, University of Manchester, Manchester, UK
| | - Nagesh Kalakonda
- Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, UK
| | - Andrea Kuhnl
- Department of Haematology, King's College Hospital, London, UK
| | - Pam McKay
- Department of Haematology, Beatson West of Scotland Cancer Centre, Glasgow, UK
| | - Andrew J Davies
- Cancer Sciences Division, Centre for Cancer Immunology, University of Southampton, Southampton, UK
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2
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Dhuri K, Pradeep SP, Shi J, Anastasiadou E, Slack FJ, Gupta A, Zhong XB, Bahal R. Simultaneous Targeting of Multiple oncomiRs with Phosphorothioate or PNA-Based Anti-miRs in Lymphoma Cell Lines. Pharm Res 2022; 39:2709-2720. [PMID: 36071352 PMCID: PMC9879158 DOI: 10.1007/s11095-022-03383-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Accepted: 08/27/2022] [Indexed: 01/29/2023]
Abstract
PURPOSE MicroRNAs (miRNAs) are short (~ 22 nts) RNAs that regulate gene expression via binding to mRNA. MiRNAs promoting cancer are known as oncomiRs. Targeting oncomiRs is an emerging area of cancer therapy. OncomiR-21 and oncomiR-155 are highly upregulated in lymphoma cells, which are dependent on these oncomiRs for survival. Targeting specific miRNAs and determining their effect on cancer cell progression and metastasis have been the focus of various studies. Inhibiting a single miRNA can have a limited effect, as there may be other overexpressed miRNAs present that may promote tumor proliferation. Herein, we target miR-21 and miR-155 simultaneously using nanoparticles delivered two different classes of antimiRs: phosphorothioates (PS) and peptide nucleic acids (PNAs) and compared their efficacy in lymphoma cell lines. METHODS Poly-Lactic-co-Glycolic acid (PLGA) nanoparticles (NPs) containing PS and PNA-based antimiR-21 and -155 were formulated, and comprehensive NP characterizations: morphology (scanning electron microscopy), size (differential light scattering), and surface charge (zeta potential) were performed. Cellular uptake analysis was performed using a confocal microscope and flow cytometry analysis. The oncomiR knockdown and the effect on downstream targets were confirmed by gene expression (real time-polymerase chain reaction) assay. RESULTS We demonstrated that simultaneous targeting with NP delivered PS and PNA-based antimiRs resulted in significant knockdown of miR-21 and miR-155, as well as their downstream target genes followed by reduced cell viability ex vivo. CONCLUSIONS This project demonstrated that targeting miRNA-155 and miR-21 simultaneously using nanotechnology and a diverse class of antisense oligomers can be used as an effective approach for lymphoma therapy.
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Affiliation(s)
- Karishma Dhuri
- Department of Pharmaceutical Science, University of Connecticut, Storrs, CT, 06269, USA
| | - Sai Pallavi Pradeep
- Department of Pharmaceutical Science, University of Connecticut, Storrs, CT, 06269, USA
| | - Jason Shi
- Department of Pharmaceutical Science, University of Connecticut, Storrs, CT, 06269, USA
| | - Eleni Anastasiadou
- HMS Initiative for RNA Medicine, Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Frank J Slack
- HMS Initiative for RNA Medicine, Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, 02115, USA
| | - Anisha Gupta
- School of Pharmacy, University of Saint Joseph, West Hartford, CT, 06117, USA
| | - Xiao-Bo Zhong
- Department of Pharmaceutical Science, University of Connecticut, Storrs, CT, 06269, USA
| | - Raman Bahal
- Department of Pharmaceutical Science, University of Connecticut, Storrs, CT, 06269, USA.
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Shin C, Kim SS, Jo YH. Extending traditional antibody therapies: Novel discoveries in immunotherapy and clinical applications. Mol Ther Oncolytics 2021; 22:166-179. [PMID: 34514097 PMCID: PMC8416972 DOI: 10.1016/j.omto.2021.08.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Immunotherapy has been well regarded as one of the safer and antigen-specific anti-cancer treatments compared to first-generation chemotherapy. Since Coley's discovery, researchers focused on engineering novel antibody-based therapies. Including artificial and modified antibodies, such as antibody fragments, antibody-drug conjugates, and synthetic mimetics, the variety of immunotherapy has been rapidly expanding in the last few decades. Genetic and chemical modifications to monoclonal antibody have been brought into academia, in vivo trials, and clinical applications. Here, we have looked around antibodies overall. First, we elucidate the antibody structure and its cytotoxicity mechanisms. Second, types of therapeutic antibodies are presented. Additionally, there is a summarized list of US Food and Drug Administration (FDA)-approved therapeutic antibodies and recent clinical trials. This review provides a comprehensive overview of both the general function of therapeutic antibodies and a few main variations in development, including recent advent with the proposed mechanism of actions, and we introduce types of therapeutic antibodies, clinical trials, and approved commercial immunotherapeutic drugs.
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Affiliation(s)
- Charles Shin
- Chadwick International, Incheon 22002, Republic of Korea
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Sung Soo Kim
- Biomedical Science Institute, Kyung Hee University, Seoul 02447, Republic of Korea
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Yong Hwa Jo
- Department of Biochemistry and Molecular Biology, School of Medicine, Kyung Hee University, Seoul 02447, Republic of Korea
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4
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Achufusi TG, Jessamy K, Zamora E, Ozden N. Quadruple therapy for gastric high-grade B-cell lymphoma. Proc (Bayl Univ Med Cent) 2020; 33:427-429. [PMID: 32675974 DOI: 10.1080/08998280.2020.1757956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Revised: 04/10/2020] [Accepted: 04/16/2020] [Indexed: 10/24/2022] Open
Abstract
Most low-grade gastric lymphomas arising from the mucosa-associated lymphoid tissue (MALT) are directly related to Helicobacter pylori infection. Most cases of MALT lymphoma limited to the stomach can be cured with H. pylori eradication and remain in remission for years. In contrast, high-grade lymphomas of the stomach, although potentially related to H. pylori, do not usually respond to H. pylori eradication. Here, we present the case of a woman with high-grade diffuse large B-cell lymphoma who achieved complete remission following H. pylori eradication.
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Affiliation(s)
- Ted George Achufusi
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Kegan Jessamy
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Ernesto Zamora
- Department of Internal Medicine, State University of New York Upstate Medical UniversitySyracuseNew York
| | - Nuri Ozden
- Department of Gastroenterology, State University of New York Upstate Medical UniversitySyracuseNew York
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5
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Bai Z, Li Z, Guan T, Wang L, Wang J, Wu S, Su L. Primary Gastric Diffuse Large B-Cell Lymphoma: Prognostic Factors in the Immuno-Oncology Therapeutics Era. Turk J Haematol 2020; 37:193-202. [PMID: 32160735 PMCID: PMC7463217 DOI: 10.4274/tjh.galenos.2020.2019.0332] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Objective: This study aimed to explore the prognostic factors for primary gastric diffuse large B-cell lymphoma (PG-DLBCL). Materials and Methods: This retrospective study analyzed 72 PG-DLBCL patients between January 2012 and December 2017 in the Shanxi Cancer Hospital of Shanxi Medical University to identify the different prognostic factors in PG-DLBCL. The clinical features, treatment, and follow-up information were analyzed. Results: The low CD4:CD8 ratio group (median subsequent overall survival [OS]: 36.06 months; 95% confidence interval [CI]: 25.73-46.40) showed a significant decrease in subsequent OS compared to the normal group among PG-DLBCL patients who were newly diagnosed and did not receive rituximab (median OS: 52.58 months; 95% CI: 44.18-60.97; p=0.029). Event-free survival status 24 months after the date of diagnosis (EFS24) also decreased significantly in the low CD4:CD8 group (median EFS24: 16.27 months; 95% CI: 13.09-19.45) compared to the normal group (median EFS24: 20.34 months; 95% CI: 17.05-23.63; p=0.014). Multivariate analysis showed that low CD4:CD8 at diagnosis was an independent poor prognostic factor for subsequent OS and EFS24. Conclusion: Our data suggest that identifying prognostic factors, especially host immunity, may provide useful information for assessing prognosis or clinical management.
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Affiliation(s)
- ZhiMin Bai
- Shanxi Medical University, Taiyuan, Shanxi, China
| | - ZhenHua Li
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - Tao Guan
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - LieYang Wang
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - JingRong Wang
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - ShaoHua Wu
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
| | - LiPing Su
- Department of Hematology, Shanxi Tumor Hospital affiliated to Shanxi Medical University, Taiyuan, Shanxi, China
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6
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Ishikawa E, Nakamura M, Shimada K, Tanaka T, Satou A, Kohno K, Sakakibara A, Furukawa K, Yamamura T, Miyahara R, Nakamura S, Kato S, Fujishiro M. Prognostic impact of PD-L1 expression in primary gastric and intestinal diffuse large B-cell lymphoma. J Gastroenterol 2020; 55:39-50. [PMID: 31493237 DOI: 10.1007/s00535-019-01616-3] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 08/19/2019] [Indexed: 02/04/2023]
Abstract
BACKGROUND Diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease and the most common gastrointestinal lymphoma. The prognostic/predictive indicators among patients with gastric and intestinal DLBCL (giDLBCL) are controversial beyond their anatomical sites. We compared giDLBCL cases and investigated the clinical utility of newly emerging indicators with an emphasis on programmed cell death ligand 1 (PD-L1) expression. METHODS This retrospective study included 174 patients with primary gastric (n = 129) or intestinal (n = 45) DLBCL treated with rituximab-containing chemotherapy between 1995 and 2018. RESULTS Compared with gastric DLBCL (gDLBCL) cases, patients with intestinal DLBCL (iDLBCL) had a significantly higher rate of advanced Lugano stage (71% vs 37%, P < 0.001), perforation (13% vs. 0.8%, P = 0.001), PD-L1 expression on microenvironment immune cells (miPD-L1, 70% vs 46%, P = 0.008), CD10 positivity (47% vs 28%, P = 0.027), and CD5 positivity (9% vs 1.6%, P = 0.040). The iDLBCL patients showed significantly worse progression-free survival (PFS) and overall survival (OS) than gDLBCL cases (P = 0.0338 and P = 0.0077, respectively). PD-L1 expression on tumor cells was detected in only 3 (2%) of 174 cases with early relapse and/or an aggressive clinical course; whereas, miPD-L1-positive cases had significantly better OS than the miPD-L1-negative gDLBCL and iDLBCL cases (P = 0.0281 and P = 0.0061, respectively). Multivariate analysis revealed that miPD-L1 negativity (P = 0.030) was an independent adverse prognostic factor for OS in giDLBCL. CONCLUSIONS The anatomical site of disease did not influence outcome in giDLBCL cases treated with rituximab-containing chemotherapy; while, miPD-L1 expression had a favorable impact on the outcome.
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Affiliation(s)
- Eri Ishikawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan. .,Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan.
| | - Masanao Nakamura
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Kazuyuki Shimada
- Department of Hematology and Oncology, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Tsutomu Tanaka
- Department of Endoscopy, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, Nagakute, Japan
| | - Kei Kohno
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Ayako Sakakibara
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Kazuhiro Furukawa
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Takeshi Yamamura
- Department of Endoscopy, Nagoya University Hospital, Nagoya, Japan
| | - Ryoji Miyahara
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Seiichi Kato
- Department of Pathology and Molecular Diagnostics, Aichi Cancer Center Hospital, Nagoya, Japan
| | - Mitsuhiro Fujishiro
- Department of Gastroenterology and Hepatology, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466-8560, Aichi, Japan
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7
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Soyer N, Yilmaz AF, Özsan N, Şahin F, Saydam G, Tombuloğlu M, Hekimgil M, Vural F. Retrospective analysis of primary gastric diffuse largeB-cell lymphoma: a single center study from Turkey. Turk J Med Sci 2017; 47:240-245. [PMID: 28263496 DOI: 10.3906/sag-1510-40] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 06/12/2016] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND/AIM Diffuse large B-cell primary gastric lymphomas (DLBC-PGLs) are treated with different therapies. Their optimal treatment is not well documented. MATERIALS AND METHODS We retrospectively analyzed the data of 51 patients diagnosed with DLBC-PGL in the previous 10 years. All patients were treated with R-CHOP as first line. Radiotherapy was added to chemotherapy in 8 patients. Surgery was performed in 5 patients. RESULTS The median follow-up time of the 51 patients was 45.5 (range 5-144) months and the complete response (CR) rate was 90.2%. CR was achieved in 34 (89.4%) of 38 patients treated with single chemotherapy, in all (100%) 5 patients treated with chemotherapy plus surgery, and in 7 (87.5%) of 8 patients treated with chemotherapy plus radiotherapy. The 5-year overall survival (OS) and event-free survival (EFS) rates were 85.8% and 89.6%, respectively. The 5-year OS and EFS rates were not significantly different between patients treated with single chemotherapy or chemotherapy plus radiotherapy/surgery (P > 0.05). CONCLUSION R-CHOP chemotherapy is as effective as R-CHOP plus radiotherapy/surgery in the treatment of DLBC-PGL patients. Prospective randomized large cohort studies are needed to generate guidelines for the treatment of DLBC-PGL.
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Affiliation(s)
- Nur Soyer
- Department of Hematology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Asu Fergün Yilmaz
- Department of Hematology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Nazan Özsan
- Department of Pathology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Fahri Şahin
- Department of Hematology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Güray Saydam
- Department of Hematology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Murat Tombuloğlu
- Department of Hematology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Mine Hekimgil
- Department of Pathology, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Filiz Vural
- Department of Hematology, Faculty of Medicine, Ege University, İzmir, Turkey
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8
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Abstract
The use of B cell depletion as a mode of treatment for non-Hodgkin’s lymphoma was first utilized in 1997 when Rituximab, a chimeric human-mouse monoclonal antibody which has a high affinity to the CD20 antigen expressed on B cells, became available. Over 500 000 lymphoma patients have been treated worldwide with this drug and it has a good safety record. The notion that B cells might be critical to the development of rheumatoid arthritis led to the extension of the use of B cell depletion to this condition and a recent double blind controlled trial has shown very encouraging results. In addition, B cell depletion either using Rituximab alone, or in combination with cyclophosphamide and corticosteroids has also been reported to have been of great benefit in some patients with severe systemic lupus erythematosus albeit in open label studies. This review considers the mechanism of action of the drug, the clinical trials that have been reported, and tries to place its current use in patients with autoimmune rheumatic disease in context.
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Affiliation(s)
- S A Chambers
- Centre for Rheumatology, The Middlesex Hospital, University College, London, UK
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9
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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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10
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Treatment modalities in primary gastric lymphoma: the effect of rituximab and surgical treatment. A study by the Anatolian Society of Medical Oncology. Contemp Oncol (Pozn) 2014; 18:273-8. [PMID: 25258586 PMCID: PMC4171466 DOI: 10.5114/wo.2014.40556] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Revised: 01/22/2014] [Accepted: 01/29/2014] [Indexed: 01/22/2023] Open
Abstract
Aim of the study Gastrointestinal lymphoma is the most common type of extranodal lymphoma and commonly involved site is the stomach. We have compared the superiority between treatment modalities for primary gastric lymphoma and we want to investigate efficacy of rituximab in gastric lymphoma. Material and methods Between April 2002 and December 2011, 146 patients with a histologically confirmed primary gastric lymphoma, initially diagnosed at eight different Cancer Centers within Turkey were evaluated retrospectively. According to the treatment modality, the patients were divided into chemotherapy (CT) alone, chemotherapy and radiotherapy (CRT), surgery and chemotherapy (SCT), surgery along with chemotherapy and radiotherapy (SCRT), and surgery (S) alone groups. Results Median follow-up period was 25.5 months. The 5-year EFS (event free survival) and OS (overall survival) rates for the patients were 55% and 62.3% respectively. In Log rank analysis of OS and EFS, we have identified levels of albumin and hemoglobine, IPI score, stage at diagnosis as factors influencing survival. In multivariate analysis of OS and EFS, only albumin and stage at diagnosis were factors independently contributing to survival. There was no statistically significant difference in terms of survival between different treatment modalities (p = 0.707 in EFS and p = 0.124 in OS). In analysis of patients treated with chemotherapy alone, there was no a statistically significant difference in terms of EFS and OS between chemotherapy regimens with or without rituximab in localized and advanced stage groups (p = 0.264 and p = 0.639). There was no statistical difference in survival rate (EFS and OS) between surgical or non-surgical treatment modalities for localized/advanced stage gastric lymphoma groups (p = 0.519 / p = 0.165). Conclusions There are several treatment options due to similar results in different treatment modalities. Also benefit of rituximab treatment in gastric lymphoma is still a controversial subject. Additional prospective trials are definitely required in order to clarify use of rituximab in treatment of extranodal gastric lymphoma.
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11
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A retrospective analysis of primary gastric diffuse large B-cell lymphoma with or without concomitant mucosa-associated lymphoid tissue (MALT) lymphoma components. Ann Hematol 2013; 92:807-15. [PMID: 23417758 DOI: 10.1007/s00277-013-1701-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2012] [Accepted: 02/05/2013] [Indexed: 02/07/2023]
Abstract
Primary gastric diffuse large B-cell lymphoma (DLBCL) is a heterogeneous disease entity that includes patients with (DLBCL/MALT) and without detectable mucosa-associated lymphoid tissue (MALT) lymphoma components (de novo DLBCL). We sought to evaluate the clinical characteristics and outcome of this disease in a large number of cases. Patients with primary gastric DLBCL (n=162) seen on 2001-2011 at the Tianjin Medical University Cancer Institute and Hospital and the First affiliated Hospital of Chinese PLA General Hospital were retrospectively reviewed. The distribution of sex, age, Lugano staging, and other main clinical characteristics was similar between the de novo DLBCL and DLBCL/MALT groups (p>0.05). However, the proportion of patients with a stage-modified international prognostic index (m-IPI) ≥ 2 was higher in the de novo DLBCL (34 %) than the DLBCL/MALT group (17 %) (p=0.026). In addition, the Helicobacter pylori infection rates were higher in the DLBCL/MALT (75 %) than the de novo DLBCL group (36 %) (p<0.001). Five-year progression-free survival (PFS) and overall survival (OS) estimates were similar for patients in the de novo DLBCL (p=0.705) and DLBCL/MALT groups (p=0.846). Surgical treatment did not offer survival benefits when compared with chemotherapy for 5-year PFS (p=0.607) and OS estimates (p=0.554). There were no significant differences in 5-year PFS and OS estimates for patients treated with rituximab-chemotherapy (p=0.261) or conventional chemotherapy (p=0.227). Non-GCB subtype and m-IPI ≥ 2 were independently associated with shorter OS, and advanced stages of lymphoma were independently associated with shorter PFS.
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12
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Wu YX, Liu B, Chen L, Li JH, Chen SQ. Prognostic factors of primary gastric diffuse large B cell lymphoma: a retrospective study of 75 cases in China. Ann Hematol 2012; 92:861-2. [DOI: 10.1007/s00277-012-1646-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 11/18/2012] [Indexed: 11/30/2022]
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13
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Mishima Y, Terui Y, Yokoyama M, Nishimura N, Sakajiri S, Ueda K, Kuboki Y, Nakano K, Suzuki K, Nara E, Tsuyama N, Takeuchi K, Oguchi M, Hatake K. R-CHOP with dose-attenuated radiation therapy could induce good prognosis in gastric diffuse large B cell lymphoma. Exp Hematol Oncol 2012; 1:30. [PMID: 23210663 PMCID: PMC3514105 DOI: 10.1186/2162-3619-1-30] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Accepted: 09/16/2012] [Indexed: 11/10/2022] Open
Abstract
Background The treatment strategy for gastric diffuse large cell lymphoma (DLBCL) has not been standardized in such as to the cycles of chemotherapy, dose of radiation, or necessity for the surgery. Although the results of CHOP or R-CHOP treatments have demonstrated the good prognosis, the treatments have been controversial in many cases. Methods We retrospectively analyzed 40 gastric DLBCL patients receiving chemotherapy with or without radiation in our institute. Those in stages II-IV were treated with six cycles of R-CHOP without radiation; for those in stage I, we administered three cycles of R-CHOP with radiation. Results The three-year overall survival (OS) and progression-free survival (PFS) rates were 95.2 and 91.8%, respectively. Those in stage I obtained 100% of OS. The radiation dose prescribed was 30.6 Gy for CR cases and 39.6 to 40 Gy for PR after chemotherapy. Although survival rates tended to correlate with staging groups or age-adjusted IPI classifications, multivariate statistical analysis did not show clear differences. All 14 patients with initial bleeding were successfully managed without surgery during treatment. Conclusion R-CHOP therapy was very effective for gastric DLBCL. It may be not necessary to use more than 30.6 Gy of radiotherapy in the highly chemo-sensitive cases. Less toxic treatments should be made available to gastric DLBCL patients.
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Affiliation(s)
- Yuko Mishima
- Division of Hematology, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
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14
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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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15
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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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16
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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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17
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Helicobacter pylori eradication therapy is effective in the treatment of early-stage H pylori-positive gastric diffuse large B-cell lymphomas. Blood 2012; 119:4838-44; quiz 5057. [PMID: 22403257 DOI: 10.1182/blood-2012-01-404194] [Citation(s) in RCA: 108] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
An explorative study evaluates the efficacy of Helicobacter pylori (HP) eradication (HPE) therapy on early-stage gastric diffuse large B-cell lymphomas (DLBCLs) without features of mucosa-associated lymphoid tissue (MALT), the pure (de novo) DLBCLs, in comparison with its efficacy on high-grade transformed gastric MALT lymphomas, the DLBCL(MALT). In total, 50 patients of stage IE/IIE1 HP-positive gastric DLBCLs with frontline HPE treatment were included. HP infection was successfully eradicated in 100% (16/16) of the pure (de novo) DLBCL patients and 94.1% (32/34) of the DLBCL(MALT) patients. In total, 68.8% (11/16) of pure (de novo) DLBCL patients and 56.3% (18/32) of DLBCL(MALT) patients achieved complete pathologic remission (pCR) after HPE therapy. The median time to pCR was 2.1 months (95% confidence interval, 0.6%-3.7%) for pure (de novo) DLBCLs and 5.0 months (95% confidence interval, 2.8%-7.5%; P = .024) for DLBCL(MALT). At a median follow-up of 7.7 years, all patients with pCR after HPE therapy were alive and free of lymphomas, except for one patient with pure (de novo) DLBCL who died of lung cancer. Similar to DLBCL(MALT), a substantial portion of early-stage HP-positive gastric pure (de novo) DLBCLs remains HP-dependent and responds to antibiotic treatment. Prospective studies to validate the findings are warranted.
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18
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Song MK, Chung JS, Shin HJ, Moon JH, Lee JO, Lee HS, Lee SM, Lee GW, Lee SE, Kim SJ. Prognostic value of metabolic tumor volume on PET / CT in primary gastrointestinal diffuse large B cell lymphoma. Cancer Sci 2012; 103:477-82. [PMID: 22126515 DOI: 10.1111/j.1349-7006.2011.02164.x] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Primary gastrointestinal (PGI) diffuse large B cell lymphoma (DLBCL) is a relatively common disease. Recent studies indicate that measurement of maximum standardized uptake value (SUV(max)) on pretreatment for (18)F-fluorodeoxyglucose PET is an important prognostic factor in PGI DLBCL. However, there is still an association between initial tumor burden and prognosis. Thus, in the present study, we investigated whether tumor volume by PET could have a potential prognostic value to predict the outcome. From 2006 to 2009, 165 Stage I E/II E PGI DLBCL patients were enrolled in the study. One hundred and five patients received cyclophosphamide, doxorubicin, vincristine, prednisone, and rituximab (R-CHOP) only, whereas 60 patients underwent surgery plus R-CHOP. Metabolic tumor volume (MTV) was defined initial tumor burden as target GI lesion above SUV, 2.5 by PET as a contouring border. Over a median follow-up period of 36.6 months, receiver operating characteristic (ROC) analysis indicated that the best cut-off values for MTV and SUV(max) were 160.1 cm(3) and 12.0, respectively. The estimated area under the ROC curve was higher for MTV than SUV(max). Thus, MTV was a better predictor for survival than SUV(max). In patients with a low MTV (<160.1 cm(3)), there were no significant differences in survival between patients undergoing R-CHOP alone and surgery plus R-CHOP (P = 0.347 for progression-free survival [PFS]; P = 0.148 for overall survival [OS]). Conversely, in patients with a high MTV (>160.1 cm(3)), survival was longer in those who underwent surgery plus R-CHOP than in those treated with R-CHOP alone (P < 0.001 for PFS; P < 0.001 for OS). Multivariate analysis revealed that high MTV is an independent factor for predicting survival. Even in the era of rituximab, treatment of PGI DLBCL is not easy in patients with a high MTV.
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Affiliation(s)
- Moo-Kon Song
- Department of Hematology-Oncology, Pusan National University Hospital Medical Research Institute, Busan, Korea
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19
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Tanaka T, Shimada K, Yamamoto K, Hirooka Y, Niwa Y, Sugiura I, Kitamura K, Kosugi H, Kinoshita T, Goto H, Nakamura S. Retrospective analysis of primary gastric diffuse large B cell lymphoma in the rituximab era: a multicenter study of 95 patients in Japan. Ann Hematol 2011; 91:383-90. [PMID: 21822617 DOI: 10.1007/s00277-011-1306-0] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2011] [Accepted: 07/26/2011] [Indexed: 12/27/2022]
Abstract
Primary gastric diffuse large B cell lymphoma (PG-DLBCL) is common subtype of extranodal non-Hodgkin lymphoma. The optimal treatment strategy for PG-DLBCL in the rituximab era still remains unknown. To evaluate clinical outcomes of PG-DLBCL in the rituximab era, we conducted a retrospective, multicenter analysis of 95 patients with PG-DLBCL. In 58 patients with localized disease, 3-year progression-free survival (PFS) and overall survival (OS) were 91% and 91% for patients with six cycles of rituximab plus CHOP (R-CHOP) and 92% and 95% for patients with three to four cycles of R-CHOP plus radiotherapy (Log-rank test, P = 0.595 and P = 0.278, respectively). In 37 patients with advanced disease, 3-year PFS and 3-year OS were 43% and 64% for patients with R-CHOP chemotherapy with or without radiotherapy. On multivariate analysis, advanced stage and elevated serum LDH levels were independent predictors of survival in patients with PG-DLBCL. One patient with localized disease relapsed in lymph node, and eight patients with advanced disease relapsed in lymph node (n = 3), stomach (n = 2), central nervous system (CNS; n = 2), and duodenum (n = 1). Intriguingly, CNS relapse developed within 6 months after initial series of treatment (4.9 and 5.8 months, respectively), and stomach relapse developed in later phase (27.2 and 32.9 months, respectively). Clinical outcomes of PG-DLBCL were extremely favorable for localized-stage patients in the rituximab era, although these might be poor for advanced-stage patients even in the rituximab era. Further prospective analyses are warranted.
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Affiliation(s)
- Tsutomu Tanaka
- Department of Gastroenterology, Nagoya University Graduate School of Medicine, Tsuruma-cho, Showa-ku, Nagoya, Japan.
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20
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Primary gastric non-Hodgkin's lymphoma in Chinese patients: clinical characteristics and prognostic factors. BMC Cancer 2010; 10:358. [PMID: 20604963 PMCID: PMC2914701 DOI: 10.1186/1471-2407-10-358] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2009] [Accepted: 07/06/2010] [Indexed: 12/19/2022] Open
Abstract
Background Optimal management and outcome of primary gastric lymphoma (PGL) have not been well defined in the rituximab era. This study aimed to analyze the clinical characteristics, prognostic factors, and roles of different treatment modalities in Chinese patients with PGL. Methods The clinicopathological features of 83 Chinese patients with PGL were retrospectively reviewed. Staging was performed according to the Lugano staging system for gastrointestinal non-Hodgkin's lymphoma. Results The predominant pathologic subtype among Chinese patients with PGL in our study was diffuse large B cell lymphoma (DLBCL), followed by mucosa-associated lymphoid tissue (MALT) lymphoma. Among the 57 patients with gastric DLBCL, 20 patients (35.1%) were classified as the germinal center B cell-like (GCB) subtype and 37 patients (64.9%) as the non-GCB subtype. The 83 patients had a five-year overall survival (OS) and event-free survival (EFS) of 52% and 59%, respectively. Cox regression analysis showed that stage-modified international prognostic index (IPI) and performance status (PS) were independent predictors of survival. In the 67 B-cell lymphoma patients who received chemotherapy, 36 patients treated with rituximab (at least 3 cycles) had a mean OS of 72 months (95% CI 62-81) versus 62 months (95% CI 47-76) for patients without rituximab treatment (P = 0.021). Conclusion The proportion of Chinese gastric DLBCL cases with non-GCB subtype was higher than the GCB subtype. Stage-modified IPI and PS were effective prognostic factors in Chinese patients with PGL. Our data suggested that primary gastric B-cell lymphoma might have an improved outcome with rituximab in addition to chemotherapy. More studies are necessary, preferentially large prospective randomized clinical trials to obtain more information on the impact of the rituximab in the primary gastric B-cell lymphoma.
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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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22
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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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23
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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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24
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Martinelli G, Gigli F, Calabrese L, Ferrucci PF, Zucca E, Crosta C, Pruneri G, Preda L, Piperno G, Gospodarowicz M, Cavalli F, Moreno Gomez H. Early stage gastric diffuse large B-cell lymphomas: results of a randomized trial comparing chemotherapy alone versus chemotherapy + involved field radiotherapy. (IELSG 4). [corrected]. Leuk Lymphoma 2009; 50:925-31. [PMID: 19479614 DOI: 10.1080/10428190902912478] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Here, we present the results of a randomised clinical trial carried out between 1998 and 2004, evaluating the possible role of radiotherapy (RT) as consolidation treatment after induction chemotherapy (CT) in diffuse large B-cell (DLBC) gastric lymphoma. Fifty-four patients were enrolled and all received anthracycline containing regimens as induction CT. Patients were evaluated after four to six cycles and those in complete remission (CR) were randomised to receive gastric involved field (IF) RT or two addition cycles of the same CT. Forty-five patients (83%) were randomised after the induction CT. Clinical results of patients allocated to the RT arm showed a significant reduction in incidence of local relapse versus patients who received CT alone. However, overall survival was not different between the two arms. Our results confirm that CT could be considered as first line therapy for newly diagnosed gastric DLBC lymphoma; IF RT delivered in those patients achieving CR after induction CT is able to prevent local relapse.
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25
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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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26
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Wirth A. The rationale and role of radiation therapy in the treatment of patients with diffuse large B-cell lymphoma in the Rituximab era. Leuk Lymphoma 2008; 48:2121-36. [PMID: 17990176 DOI: 10.1080/10428190701636468] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Developments in the evaluation and systemic management of diffuse large B-cell lymphoma (DLBCL) require ongoing assessment of the role of external beam radiotherapy in management. This review assesses data regarding the use of radiotherapy in the initial management of early stage and advanced DLBCL, and considers the implications of bulky and residual disease, and the contribution of PET scanning, to decisions regarding the use of radiotherapy after chemotherapy. Limited R-CHOP plus radiotherapy, or full dose R-CHOP alone, are both likely to cure approximately 90% of patients with low risk early stage disease. The choice of therapy will depend on considerations of acute and late toxicity of the two approaches, taking into account individual patient risk profiles and preferences. Unfavorable early-stage and advanced-stage disease require treatment with full dose R-CHOP. The presence of bulky disease predicts for a higher risk of relapse, which may be partly ameliorated by the addition of radiotherapy. The rapidity of response on PET scanning, the presence of a posttherapy residual mass, the potential toxicity of radiotherapy and the available salvage options all need to be considered on a patient by patient basis, when considering the use of radiotherapy for advanced disease.
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Affiliation(s)
- Andrew Wirth
- Peter MacCallum Cancer Centre, St Andrew's Place, East Melbourne, Victoria, Australia.
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27
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Hirata N, Tominaga K, Ohta K, Kadouchi K, Okazaki H, Tanigawa T, Shiba M, Watanabe T, Fujiwara Y, Nakamura S, Oshitani N, Higuchi K, Arakawa T. A case of mucosa-associated lymphoid tissue lymphoma forming multiple lymphomatous polyposis in the small intestine. World J Gastroenterol 2007; 13:1453-7. [PMID: 17457982 PMCID: PMC4146935 DOI: 10.3748/wjg.v13.i9.1453] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
A 50-year old woman suffering from diabetes had a CT scan that revealed a diffuse thickening of small intestinal wall and swollen paraaortic lymph nodes. An esophagogastroduodenoscopy (EGD) confirmed multiple polypoid lesions in the duodenum and small intestine, and conventional histological testing revealed non-specific inflammatory changes. Further examinations including the immunohistochemical profiles of the biopsied specimens led us to diagnose the lesion as a marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue type, forming multiple lymphomatous polyposis sequentially spreading from duodenal bulb to terminal ileum. According to Lugano’s classification, its staging was clinically diagnosed as stage II. Two courses of a standard CHOP (cyclophosphamide, doxorubicin hydrochloride, vincristine sulfate, and predonisolone) regimen with rituximab reduced the lesion and the patient had a almost complete response. A 5-year follow-up EGD and histological examinations detected no recurrence of the disease.
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MESH Headings
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Biopsy
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Endoscopy, Digestive System
- Female
- Humans
- Intestinal Polyposis/diagnosis
- Intestinal Polyposis/etiology
- Intestine, Small/pathology
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Middle Aged
- Prednisolone/administration & dosage
- Rituximab
- Vincristine/administration & dosage
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Affiliation(s)
- Naoto Hirata
- Department of Gastroenterology, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka 545-8585, Japan
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28
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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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Vlachaki E, Perifanis V, Haralambidou S, Tsatra I, Koussi A, Paraskeuopoulos P, Staurogianni N, Athanasiou M. A case of primary gastric lymphoma in a patient with thalassemia major. Leuk Lymphoma 2006; 47:1979-81. [PMID: 17065019 DOI: 10.1080/10428190600667796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
MESH Headings
- Adult
- Female
- Humans
- Lymphoma, B-Cell, Marginal Zone/etiology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Lymphoma, Large B-Cell, Diffuse/etiology
- Lymphoma, Large B-Cell, Diffuse/pathology
- Lymphoma, Large B-Cell, Diffuse/therapy
- Stomach Neoplasms/etiology
- Stomach Neoplasms/pathology
- Stomach Neoplasms/therapy
- Thalassemia/complications
- Thalassemia/therapy
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Wöhrer S, Troch M, Raderer M. Treatment of Localized Primary Gastric Lymphoma. J Clin Oncol 2006; 24:2682; author reply 2682-3. [PMID: 16763284 DOI: 10.1200/jco.2006.06.1622] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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31
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Yamashita H, Izutsu K, Nakamura N, Shiraishi K, Chiba S, Kurokawa M, Tago M, Igaki H, Ohtomo K, Nakagawa K. Treatment results of chemoradiation therapy for localized aggressive lymphomas: A retrospective 20-year study. Ann Hematol 2006; 85:523-9. [PMID: 16691398 DOI: 10.1007/s00277-006-0114-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2006] [Accepted: 02/24/2006] [Indexed: 10/24/2022]
Abstract
In this study we analyzed our cases of localized aggressive lymphoma treated in our institution during the last 20 years to compare the finding of this study with those of previous studies. Forty patients with Ann Arbor stage I-II aggressive lymphoma were treated with 3-6 cycles of a CHOP regimen (cyclophosphamide, doxorubicin, vincristine, and prednisolone) and radiation therapy (30 or 40 Gy with involved field). Between 1985 and 2003, 40 patients with stage I (N = 25) or stage II (N = 15) disease were treated. Chemotherapy mainly preceded radiotherapy, although the sequence of radiotherapy and chemotherapy was determined by individual physicians and patients' choice. Median and mean age was 50.5 and 48.6 years, respectively, at the time of diagnosis, with a male to female ratio of 19:21. Analyses were undertaken to determine (1) response to treatment according to age, international prognostic index (IPI), lactate dehydrogenase (LDH) value, serum interleukin 2 receptor (sIL-2R) value, cell type, stage, extent of maximum local disease, with or without mediastinal lymph nodes, number of sites, anatomic distribution, and irradiation dose, and (2) relapse patterns. Complete follow-up was obtained in all patients. The follow-up period of surviving 33 patients ranged from 24.7 to 180 months with a median of 69 and a mean of 72.7 months. A complete remission (CR) was achieved in 37 patients (93%). A study of relapse patterns after a CR showed that four patients had a first relapse within a radiation field and the other one patient had an extranodal distant relapse. Significant prognostic factors were not identified by multivariate analysis. Combined chemotherapy and radiation therapy is safe, highly effective, and probably curative for most patients with stage I-II aggressive lymphoma.
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Affiliation(s)
- Hideomi Yamashita
- Department of Radiology, University of Tokyo Hospital, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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Grimison PS, Chin MT, Harrison ML, Goldstein D. Primary pancreatic lymphoma--pancreatic tumours that are potentially curable without resection, a retrospective review of four cases. BMC Cancer 2006; 6:117. [PMID: 16674812 PMCID: PMC1475874 DOI: 10.1186/1471-2407-6-117] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2006] [Accepted: 05/04/2006] [Indexed: 12/11/2022] Open
Abstract
Background Primary pancreatic lymphomas (PPL) are rare tumours of the pancreas. Symptoms, imaging and tumour markers can mimic pancreatic adenocarcinoma, but they are much more amenable to treatment. Treatment for PPL remains controversial, particularly the role of surgical resection. Methods Four cases of primary pancreatic lymphoma were identified at Prince of Wales Hospital, Sydney, Australia. A literature review of cases of PPL reported between 1985 and 2005 was conducted, and outcomes were contrasted. Results All four patients presented with upper abdominal symptoms associated with weight loss. One case was diagnosed without surgery. No patients underwent pancreatectomy. All patients were treated with chemotherapy and radiotherapy, and two of four patients received rituximab. One patient died at 32 months. Three patients are disease free at 15, 25 and 64 months, one after successful retreatment. Literature review identified a further 103 patients in 11 case series. Outcomes in our series and other series of chemotherapy and radiotherapy compared favourably to surgical series. Conclusion Biopsy of all pancreatic masses is essential, to exclude potentially curable conditions such as PPL, and can be performed without laparotomy. Combined multimodality treatment, utilising chemotherapy and radiotherapy, without surgical resection is advocated but a cooperative prospective study would lead to further improvement in treatment outcomes.
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Affiliation(s)
- Peter S Grimison
- Institute of Oncology, Prince of Wales Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Melvin T Chin
- Institute of Oncology, Prince of Wales Hospital, Sydney, Australia
| | | | - David Goldstein
- Institute of Oncology, Prince of Wales Hospital, Sydney, Australia
- Faculty of Medicine, University of New South Wales, Sydney, Australia
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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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34
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Park YH, Lee JJ, Ryu MH, Kim SY, Kim DH, Do YR, Lee KH, Oh SJ, Kim YK, Suh CW, Heo DS, Ryoo BY, Kim JK, Song HS, Lee WS, Kim HJ, Bang YJ, Yang SH, Sohn SK, Kang YK. Improved therapeutic outcomes of DLBCL after introduction of rituximab in Korean patients. Ann Hematol 2006; 85:257-62. [PMID: 16416337 DOI: 10.1007/s00277-005-0060-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2005] [Accepted: 11/24/2005] [Indexed: 10/25/2022]
Abstract
The addition of rituximab to cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) has been shown to improve the outcome in all age groups with newly diagnosed diffuse large B-cell lymphoma (DLBCL). We conducted a retrospective analysis to evaluate the impact of this combination therapy on DLBCL outcomes in Korea. From October 2001 to June 2004, newly diagnosed DLBCL patients in nine Korean institutes were included. All of these 81 patients were treated with three or more cycles of rituximab plus CHOP (R-CHOP) combination chemotherapy (R group), and followed for a minimum of 12 months. For comparison, a historical cohort of patients was used and analyzed for "Clinicopathologic characteristics of Korean non-Hodgkin's lymphomas (NHLs) based on Revised American Lymphoma (REAL) classification" in 1999. Among the 1,098 NHL patients, the data of 214 DLBCL patients, who were treated with CHOP chemotherapy in first-line, were analyzed (C group). We compared outcomes between the C group and the R group. A total of 295 patients were evaluated (C group, 214; R group, 81). The complete response (CR) rate was higher in R group (73 vs 91%, p=0.001). The 2-year event-free survival (EFS) rate was significantly higher in R group (78 vs 85%, p=0.0194). This survival benefit was maintained in high-risk patients according to the international prognostic index (IPI) (p=0.0039), regardless of age. However, there was no significant difference in low-risk patients. The addition of rituximab to CHOP combination chemotherapy for DLBCLs showed improved outcomes, particularly in high-risk group according to the IPI. Long-term follow-up results will be needed to confirm these results.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/standards
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cohort Studies
- Cyclophosphamide/administration & dosage
- Cyclophosphamide/standards
- Cyclophosphamide/therapeutic use
- Data Interpretation, Statistical
- Disease-Free Survival
- Dose-Response Relationship, Drug
- Doxorubicin/administration & dosage
- Doxorubicin/standards
- Doxorubicin/therapeutic use
- Drug Administration Schedule
- Female
- Humans
- Infusions, Intravenous
- Korea
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/drug therapy
- Lymphoma, B-Cell/radiotherapy
- Lymphoma, Large B-Cell, Diffuse/diagnosis
- Lymphoma, Large B-Cell, Diffuse/drug therapy
- Lymphoma, Large B-Cell, Diffuse/radiotherapy
- Male
- Middle Aged
- Multivariate Analysis
- Neoplasm Staging
- Prednisone/administration & dosage
- Prednisone/standards
- Prednisone/therapeutic use
- Regression Analysis
- Retrospective Studies
- Rituximab
- Survival Analysis
- Treatment Outcome
- Vincristine/administration & dosage
- Vincristine/standards
- Vincristine/therapeutic use
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Affiliation(s)
- Y H Park
- Korea Cancer Center Hospital, Seoul, South 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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36
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Nakamura S, Matsumoto T, Suekane H, Nakamura S, Matsumoto H, Esaki M, Yao T, Iida M. Long-term clinical outcome of Helicobacter pylori eradication for gastric mucosa-associated lymphoid tissue lymphoma with a reference to second-line treatment. Cancer 2005; 104:532-40. [PMID: 15937928 DOI: 10.1002/cncr.21152] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND The goals of the current study were to elucidate the long-term outcome of Helicobacter pylori eradication therapy for gastric mucosa-associated lymphoid tissue (MALT) lymphoma and to clarify the therapeutic efficacy of stomach-conserving treatments for patients not responding to eradication therapy. METHODS Ninety-six patients with gastric MALT lymphoma, including 17 patients with areas of diffuse large B-cell lymphoma, were treated by H. pylori eradication. Patients not responding to eradication therapy underwent either a gastrectomy, multiagent chemotherapy, oral monochemotherapy (OMC), or radiotherapy (RT). Predictive factors for the response to eradication therapy, overall survival (OS), and event-free survival (EFS) were determined by the Kaplan-Meier analysis with the log-rank test. The efficacy of second-line treatment was compared between OMC and RT. RESULTS After eradication therapy, 62 (65%) patients achieved complete disease remission (CR). Transient histologic disease recurrence was confirmed in 4 (6.5%) of 62 patients with CR during the follow-up (median, 37.5 months). The OS and EFS probabilities after 5 years were 0.96 and 0.80, respectively. Second-line treatment was performed in 31 patients; gastrectomy in 4 patients, multiagent chemotherapy in 5 patients, OMC in 12 patients, and RT in 10 patients. There were no differences in the CR rate, OS, EFS, or toxicity between the OMC and RT groups. CONCLUSIONS H. pylori eradication therapy was an effective first-line treatment for patients with gastric MALT lymphoma, which led to a favorable long-term outcome. OMC and RT had an equivalent efficacy as a second-line treatment in nonresponding patients to eradication therapy.
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MESH Headings
- Adolescent
- Adult
- Aged
- Aged, 80 and over
- Anti-Infective Agents/therapeutic use
- Antibodies, Monoclonal/administration & dosage
- Antibodies, Monoclonal, Murine-Derived
- Antineoplastic Combined Chemotherapy Protocols/administration & dosage
- Antineoplastic Combined Chemotherapy Protocols/therapeutic use
- Cyclophosphamide/administration & dosage
- Doxorubicin/administration & dosage
- Drug Therapy, Combination
- Female
- Helicobacter Infections/complications
- Helicobacter Infections/drug therapy
- Helicobacter pylori
- Humans
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Lymphoma, B-Cell, Marginal Zone/radiotherapy
- Lymphoma, Large B-Cell, Diffuse
- Male
- Middle Aged
- Prednisolone/administration & dosage
- Prospective Studies
- Rituximab
- Stomach Neoplasms/drug therapy
- Stomach Neoplasms/microbiology
- Stomach Neoplasms/radiotherapy
- Survival Rate
- Treatment Outcome
- Vincristine/administration & dosage
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Affiliation(s)
- Shotaro Nakamura
- Department of Medicine and Clinical Science, Graduate School of Medical Sciences, Kyushu University, Maidashi 3-1-1, Higashi-ku, Fukuoka 812-8582, Japan.
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37
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38
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Ishikura S, Tobinai K, Ohtsu A, Nakamura S, Yoshino T, Oda I, Takagi T, Mera K, Kagami Y, Itoh K, Tamaki Y, Suzumiya J, Taniwaki M, Yamamoto S. Japanese multicenter phase II study of CHOP followed by radiotherapy in stage I-II, diffuse large B-cell lymphoma of the stomach. Cancer Sci 2005; 96:349-52. [PMID: 15958057 PMCID: PMC11159192 DOI: 10.1111/j.1349-7006.2005.00051.x] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) followed by radiotherapy is regarded as standard care for localized aggressive lymphoma; however, prospective confirmation of its applicability to localized primary gastric lymphoma is inadequate, and most patients in Japan have been initially treated with gastrectomy. We conducted a multicenter phase II study to evaluate the feasibility and efficacy of the non-surgical treatment. Eligibility criteria required primary gastric diffuse large B-cell lymphoma, stage I-II(1), age 20-75, performance status 0-1 and adequate organ function. Treatment consisted of three cycles of CHOP followed by radiotherapy 40.5 Gy. Fifty-five patients were enrolled between December 1999 and February 2003, and 52 eligible patients were analyzed. Patient characteristics were as follows: median age, 61 years; 28 men, 24 women; 36 with stage I, 16 with stage II(1); 47 with a low International Prognostic Index (IPI) and five with a low-intermediate IPI. All but one patient completed planned treatment. No serious complications including massive hemorrhage or perforation were observed. A complete response was achieved in 48 of the 52 patients (92%, 95% confidence interval: 82-98%) and progressive disease in three. Two patients underwent salvage gastrectomy due to disease persistence or recurrence. With a median follow-up period of 28 months, 2-year progression-free and overall survivals were 88 and 94%, respectively. CHOP followed by radiotherapy is safe and highly effective in localized gastric diffuse large B-cell lymphoma. This organ-preserving treatment should be considered as a very reasonable therapeutic option.
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Affiliation(s)
- Satoshi Ishikura
- Radiation Oncology Division, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa 277-8577, Japan.
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