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Liu X, Cao D, Liu H, Ke D, Ke X, Xu X. Clinical Features Analysis and Survival Nomogram of Primary Small Intestinal Diffuse Large B-Cell Lymphoma. Cancer Manag Res 2022; 14:2639-2648. [PMID: 36090469 PMCID: PMC9462437 DOI: 10.2147/cmar.s369086] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 08/27/2022] [Indexed: 12/15/2022] Open
Abstract
Purpose This study aimed to analyze the clinical features and survival of primary small intestinal diffuse large B-cell lymphoma (PsI-DLBCL), and establish and independently validate a prognostic nomogram for individual risk prediction. Patients and methods Data for 24 patients from the Renmin Hospital of Wuhan University were used as an independent validation cohort, data for 1144 patients with PsI-DLBCL from the SEER database were randomly assigned to training (N=817) and internal validation (N=327) sets. The survival nomogram was constructed with the most significant factors associated with OS using Univariate and multivariate analyses on the training set. Decision curve analysis (DCA) was conducted. Internal validation was SEER validation set. Our cancer center cohort was used as an external validation set to further verify the survival nomogram. Results Five clinicopathological feature factors associated with OS of the training set yielded (age, marital status, Ann Arbor stage, surgery for primary site and chemotherapy), which were used to create a survival nomogram. Additionally, the calibration curves of the prognostic nomogram revealed good agreement between the predicted survival probabilities and the ground truth values. The stability of our survival nomogram was explained by internal and external validation data. Conclusion Our nomogram proposes the clinical and therapeutic factors affecting OS for patients with PsI-DLBCL. It shows that chemotherapy and surgery are beneficial to patients in the choice of treatment options. These results suggest that a survival nomogram may be better at predicting OS for PsI-DLBCL patients.
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Affiliation(s)
- Xiaohong Liu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Dedong Cao
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Hui Liu
- Department of Hematology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Dong Ke
- Department of Gastrointestinal Surgery, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Xiaokang Ke
- Department of Pathology; Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
| | - Ximing Xu
- Department of Oncology, Renmin Hospital of Wuhan University, Wuhan, 430060, People's Republic of China
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2
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Bai Z, Zhou Y. A systematic review of primary gastric diffuse large B-cell lymphoma: Clinical diagnosis, staging, treatment and prognostic factors. Leuk Res 2021; 111:106716. [PMID: 34627052 DOI: 10.1016/j.leukres.2021.106716] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/19/2021] [Accepted: 09/26/2021] [Indexed: 01/05/2023]
Abstract
Primary gastric lymphoma (PGL) is a rare clinical entity accounting for the majority of extra-nodal non-Hodgkin lymphoma (EN-NHL). The most common histological subtype is the primary gastric diffuse large B-cell lymphoma (PG-DLBCL) with a media age of 50-60 years old, mostly in male. Pathogenesis is often related to some bacterial infection such as Helicobacter pylori (H. pylori) infection. However, due to various available staging system, there is still no consensus on the staging of PG-DLBCL. The international prognostic index (IPI) is the most valuable used for the stratification of almost all subtype of NHL and as well as for PG-DLBCL. As for treatment strategies, surgery, chemotherapy, radiation therapy and antibiotic therapy in various combinations have been applied in clinical treatment. There are a few well-known prognostic factors and some of them may constitute prognostic models. Due to the increasing incidence of this neoplasm, it is necessary for clinicians to make deep insight of the diagnosis, staging, treatment and prognostic factors of PG-DLBCL.
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Affiliation(s)
- Zhimin Bai
- Department of Hematology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China.
| | - Yong Zhou
- Department of Otolaryngology Head and Neck Surgery, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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3
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Alvarez-Lesmes J, Chapman JR, Cassidy D, Zhou Y, Garcia-Buitrago M, Montgomery EA, Lossos IS, Sussman D, Poveda J. Gastrointestinal Tract Lymphomas: A Review of the Most Commonly Encountered Lymphomas. Arch Pathol Lab Med 2021; 145:1585-1596. [PMID: 33836528 DOI: 10.5858/arpa.2020-0661-ra] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2021] [Indexed: 11/06/2022]
Abstract
CONTEXT.— The gastrointestinal (GI) tract is the most common site of extranodal non-Hodgkin lymphoma, accounting for 20% to 40% of all extranodal lymphomas. The majority of these are systemic processes secondarily involving the GI tract. Primary GI lymphomas are less common, accounting for approximately 10% to 15% of all non-Hodgkin lymphoma. Most non-Hodgkin lymphoma involving the GI tract are of B-cell lineage, of which diffuse large B-cell lymphoma is the most common subtype, irrespective of location. OBJECTIVE.— To review the lymphoproliferative neoplasms of B-cell and T-cell lineage involving the luminal GI tract according to the most prevalent subtypes at each anatomic site. DATA SOURCE.— Systematic search of the PubMed database for updated literature on GI lymphomas epidemiology, subtypes, clinical, endoscopic, and genetic findings. Histologic images are derived from our collection of clinical cases. CONCLUSIONS.— The GI tract is the most common site of extranodal lymphoproliferative neoplasms. Recognition of the most frequently encountered GI lymphomas is imperative for patient management and treatment.
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Affiliation(s)
- Jessica Alvarez-Lesmes
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Jennifer R Chapman
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Daniel Cassidy
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Yi Zhou
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Monica Garcia-Buitrago
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Elizabeth A Montgomery
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
| | - Izidore S Lossos
- Division of Hematology, Department of Medicine, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center, Miami, Florida (Lossos).,Department of Molecular and Cellular Pharmacology (Lossos), University of Miami Miller School of Medicine, Miami, Florida
| | - Daniel Sussman
- Division of Digestive Health and Liver Diseases (Sussman), University of Miami Miller School of Medicine, Miami, Florida
| | - Julio Poveda
- From the Department of Pathology, Division of Hematopathology, Division of Gastrointestinal Pathology, University of Miami Miller School of Medicine, Sylvester Comprehensive Cancer Center and Jackson Memorial Hospital, Miami, Florida (Alvarez-Lesmes, Chapman, Cassidy, Zhou, Garcia-Buitrago, Montgomery, Poveda)
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4
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Jiang C, Ding C, Xu J, Teng Y, Chen J, Wang Z, Zhou Z. Will Baseline Total Lesion Glycolysis Play a Role in Improving the Prognostic Value of the NCCN-IPI in Primary Gastric Diffuse Large B-Cell Lymphoma Patients Treated With the R-CHOP Regimen? Clin Nucl Med 2021; 46:1-7. [PMID: 33181743 DOI: 10.1097/rlu.0000000000003378] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE The aim was to explore whether baseline total lesion glycolysis (TLG) can improve the prognostic value of the National Comprehensive Cancer Network International Prognostic Index (NCCN-IPI) in primary gastric diffuse large B-cell lymphoma (PG-DLBCL) patients treated with an R-CHOP-like regimen. MATERIALS AND METHODS Ninety-four PG-DLBCL patients who underwent baseline PET/CT between July 2010 and May 2019 were included in this retrospective study. FDG-avid lesions in each patient were segmented to calculate the SUVmax, total metabolic tumor volume (TMTV), and TLG. Progression-free survival (PFS) and overall survival (OS) were used as end points to evaluate prognosis. RESULTS During the follow-up period of 5 to 108 months (35.3 ± 23.5 months), high TLG and a high NCCN-IPI were significantly associated with poor PFS and OS. Total lesion glycolysis and the NCCN-IPI were independent predictors of PFS and OS. Patients were stratified into 3 groups according to the combination of TLG and the NCCN-IPI for PFS (P < 0.001) and OS (P < 0.001): high-risk group (TLG > 1159.1 and NCCN-IPI 4-8) (PFS and OS, 57.7% and 61.5%, respectively, n = 42), intermediate-risk group (TLG > 1159.1 or NCCN-IPI 4-8) (PFS and OS, both 76.9%, n = 26), and low-risk group (TLG ≤ 1159.1 and NCCN-IPI 0-3) (PFS and OS, 97.6% and 100.0%, respectively, n = 26). CONCLUSIONS Both TLG and the NCCN-IPI are independent predictors of PG-DLBCL patient survival. Moreover, the combination of TLG and the NCCN-IPI improved patient risk stratification and might help personalize therapeutic regimens.
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Affiliation(s)
- Chong Jiang
- From the Department of Nuclear Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Chongyang Ding
- Department of Nuclear Medicine, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital
| | | | - Yue Teng
- From the Department of Nuclear Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Jieyu Chen
- Pathology, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
| | - Zhen Wang
- Department of Pathology, the First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Nanjing, China
| | - Zhengyang Zhou
- From the Department of Nuclear Medicine, Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School
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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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The Impact of Surgery on Long-Term Survival of Patients with Primary Gastric Diffuse Large B-Cell Lymphoma: A SEER Population-Based Study. Gastroenterol Res Pract 2019; 2019:9683298. [PMID: 30918518 PMCID: PMC6409055 DOI: 10.1155/2019/9683298] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 12/21/2018] [Accepted: 01/09/2019] [Indexed: 01/29/2023] Open
Abstract
Background The aim of this retrospective study was to compare the long-term survival of patients receiving conservative with surgical treatment to analyze the prognostic factors and the impact of surgery on oncological outcomes of patients with primary gastric diffuse large B-cell lymphoma. Methods A total of 2647 patients diagnosed with primary gastric diffuse large B-cell lymphoma from 1998 to 2014 were extracted from SEER database. Propensity matching was performed to compare the clinicopathological characteristics of the two groups. Based on the recursive partitioning analysis, the patients were divided into three risk subgroups: low risk, intermediate risk, and high risk. Results After propensity score matching, patient characteristics did not differ significantly between the two groups. The 5-year cancer-specific survival rates of the surgical group and the conservative treatment group were, respectively, 60% and 59.2% (P = 0.952) before propensity matching and 64.2% and 58.6% (P = 0.046) after propensity matching. According to the multivariate analysis, age, tumor stage, and chemotherapy and surgery were independent risk factors for long-term survival. The 5-year cancer-specific survival rates differed significantly between the low-risk, intermediate-risk, and high-risk patients (76.2% vs. 57.4% vs. 25.5%, respectively, P < 0.001). The 5-year cancer-specific survival rate of the surgical group was significantly higher than that of the conservative treatment group in the low-risk patients. However, it did not differ significantly in the intermediate-risk and high-risk patients (P > 0.05). Conclusions A prognostic model was constructed based on the independent risk factors of age, tumor stage, and chemotherapy. The prognostic model indicated that low-risk patients (age < 75 years, stage I/II, with/without chemotherapy) undergoing surgical treatment may benefit from long-term survival, while intermediate- and high-risk patients (age ≥ 75 years, stage I/II, with/without chemotherapy or III/IV patients, with/without chemotherapy) gain no significant benefit from surgery.
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7
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Kadota T, Seo S, Fuse H, Ishii G, Itoh K, Yano T, Kaneko K, Tsukasaki K. Complications and outcomes in diffuse large B-cell lymphoma with gastric lesions treated with R-CHOP. Cancer Med 2019; 8:982-989. [PMID: 30730104 PMCID: PMC6434211 DOI: 10.1002/cam4.1982] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2018] [Revised: 12/18/2018] [Accepted: 01/02/2019] [Indexed: 12/15/2022] Open
Abstract
Standard therapy for gastric diffuse large B‐cell lymphoma (DLBCL) is considered to be chemotherapy with or without involved‐field radiation therapy. Although R‐CHOP therapy alone is widely used for DLBCL with gastric lesions (DLBCL‐GL), the outcome and incidence of treatment‐related gastric complications following R‐CHOP are not well known. This study aimed to evaluate the outcome after R‐CHOP therapy in patients with gastric DLBCL including gastric complications and to identify risk factors for the complications. Consecutive patients with newly diagnosed DLBCL‐GL treated with R‐CHOP between 2003 and 2014 were retrospectively evaluated. DLBCL‐GL was defined only when pathologically confirmed in the stomach. Of the 96 patients with DLBCL‐GL, 63 patients were diagnosed with gastric symptoms. Eighty‐eight patients (92%) completed six to eight cycles of R‐CHOP. The complete remission (CR) rate was 86%, and 3‐year and 5‐year overall survival rates were 80% and 73%, respectively. Patients were well stratified according to the Revised International Prognostic Index (R‐IPI). Complication rate was 8% (8/96); seven patients had bleeding and three had stenosis. No patients had gastric perforation. Bleeding occurred during the first cycle of R‐CHOP in five patients (5/7, 71%). Patients with gastric complications had a lower R‐CHOP completion rate (50%, P = 0.001) and a lower CR rate (25%, P < 0.001) than those without complications. A low serum albumin level at diagnosis was the only risk factor identified for gastric complications (P = 0.001) and six of the eight patients with complications were shown to be at stage IV. Further studies of DLBCL‐GL are warranted to identify patients at high risk for gastric complications and to provide better treatment strategies.
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Affiliation(s)
- Tomohiro Kadota
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Hematology, National Cancer Center Hospital East, Kashiwa, Japan
| | - Sachiko Seo
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Hematology & Oncology, Dokkyo Medical University, Tochigi, Japan
| | - Hiroe Fuse
- Department of Hematology, Matsudo City General Hospital, Matsudo, Chiba, Japan
| | - Genichiro Ishii
- Division of Pathology, Exploratory Oncology Research & Clinical Trial Center (EPOC), National Cancer Center, Kashiwa, Chiba, Japan
| | - Kuniaki Itoh
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Japan.,Division of Hematology/Oncology, Kimitsu Chuo Hospital, Kisarazu, Japan
| | - Tomonori Yano
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kazuhiro Kaneko
- Department of Gastroenterology, Endoscopy Division, National Cancer Center Hospital East, Kashiwa, Japan
| | - Kunihiro Tsukasaki
- Department of Hematology, National Cancer Center Hospital East, Kashiwa, Japan.,Department of Hematology, International Medical Center, Saitama Medical University, Hidaka, Japan
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8
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Yang H, Wu M, Shen Y, Lei T, Mi L, Leng X, Ping L, Xie Y, Song Y, Cen X, Zhu J. Treatment Strategies and Prognostic Factors of Primary Gastric Diffuse Large B Cell Lymphoma: A Retrospective Multicenter Study of 272 Cases from the China Lymphoma Patient Registry. Int J Med Sci 2019; 16:1023-1031. [PMID: 31341416 PMCID: PMC6643119 DOI: 10.7150/ijms.34175] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 05/08/2019] [Indexed: 01/28/2023] Open
Abstract
Background: The respective and combinatorial roles of surgery, Rituximab and chemotherapy in primary gastric diffuse large B cell lymphoma (PGDLBCL) therapy remained unclear. The purpose of the study was to evaluate present treatment strategies and prognostic factors of PGDLBCL. Methods: 272 cases (from 1994-1 to 2015-12) were retrospectively analyzed. According to the therapy regimen, patients were classified into four groups: chemotherapy (C), chemotherapy + surgery (C+S), Rituximab + chemotherapy (R+C), and Rituximab + chemotherapy + surgery (R+C+S). Results: The 3-year progression-free survival (PFS) and 3-year overall survivals (OS) of the entire cohort were 77.0% and 81.2% respectively (median follow-up time: 44.3 months). Survival of surgery-treated patients was superior to the survival of those receiving drug therapy alone (PFS: 82.6% vs. 74.7%, p=0.015; OS: 87.8% vs. 78.6%, p=0.036). Rituximab showed significant clinical benefit in OS (87.1% vs. 75.0%, p=0.007), especially in advanced-stage or high risk (IPI 3-5) patients. Group C had the lowest PFS and OS among the four groups, while the survival of other three groups were similar (Group C vs. Group C+S vs. Group R+C vs. Group R+C+S: 3-year PFS: 67.2% vs. 81.4% vs. 81.2% vs. 81.8%, p=0.002; 3-year OS: 68.4% vs. 85.4% vs. 87.2% vs. 88.6%, p<0.001). Multivariate analysis showed that IPI and therapy regimens were highly predictive for both PFS and OS. Conclusions: Our results suggested that the combinations of chemotherapy and surgery, or chemotherapy and Rituximab, are superior to other treatment strategies for PGDLBCL. IPI and therapy regimens are independent predictors of outcomes. Future prospective trial is warranted.
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Affiliation(s)
- Haiyan Yang
- Department of Lymphoma, Zhejiang Cancer Hospital, Postal address: No. 1, Bansan Road, Hangzhou, Zhejiang, China
| | - Meng Wu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Postal address: No 52, Fucheng Road, Haidian District, Beijing, China. 100142
| | - Ye Shen
- Department of Hematology, Peking University First Hospital, Postal address: No. 8, Xishiku Street, Xicheng District, Beijing, China. 100034
| | - Tao Lei
- Department of Lymphoma, Zhejiang Cancer Hospital, Postal address: No. 1, Bansan Road, Hangzhou, Zhejiang, China
| | - Lan Mi
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of outreach and industrial Affairs, Peking University Cancer Hospital & Institute, Postal address: No 52, Fucheng Road, Haidian District, Beijing, China. 100142
| | - Xin Leng
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Postal address: No 52, Fucheng Road, Haidian District, Beijing, China. 100142
| | - Lingyan Ping
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Postal address: No 52, Fucheng Road, Haidian District, Beijing, China. 100142
| | - Yan Xie
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Postal address: No 52, Fucheng Road, Haidian District, Beijing, China. 100142
| | - Yuqin Song
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Postal address: No 52, Fucheng Road, Haidian District, Beijing, China. 100142
| | - Xinan Cen
- Department of Hematology, Peking University First Hospital, Postal address: No. 8, Xishiku Street, Xicheng District, Beijing, China. 100034
| | - Jun Zhu
- Key laboratory of Carcinogenesis and Translational Research (Ministry of Education), Department of Lymphoma, Peking University Cancer Hospital & Institute, Postal address: No 52, Fucheng Road, Haidian District, Beijing, China. 100142
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9
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Wienerroither V, Sauerschnig M, Beham-Schmid C, Mathew E, El-Shabrawi A, Mischinger HJ, Kornprat P. Operative R0 resection of diffuse large B-cell lymphoma of the pelvis: a case report. J Med Case Rep 2018; 12:293. [PMID: 30314526 PMCID: PMC6186087 DOI: 10.1186/s13256-018-1838-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 09/06/2018] [Indexed: 01/17/2023] Open
Abstract
Background Diffuse large B-cell lymphoma is the most common subtype of non-Hodgkin lymphoma with or without involvement of extranodal sites. Rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) therapy represents the current standard therapy, achieving a rather dissatisfying outcome in approximately 30–40% of all cases. Case presentation We present the case of a 43-year-old Austrian woman with an incidentally detected large pelvic mass which was diagnosed as diffuse large B-cell lymphoma. Initially, the lymphoma intraoperatively appeared to be an inoperable conglomerate tumor. Soon, intestinal perforation induced by tumor infiltration occurred, which initiated a closure of the small intestine and application of a jejunal probe and a percutaneous endoscopic gastrotomy tube. Treatment utilizing the gold standard rituximab in combination with cyclophosphamide, doxorubicin, vincristine and prednisolone (R-CHOP) was performed, partly resulting in remission according to radiological follow-up. In view of diagnosis and primary treatment development, the predictive outcome appeared unsound. However, within the procedure of the latest surgical intervention, which was intended to at least reconstruct the intestinal passage in order to improve quality of life, a surgical R0 resection of the residual tumor mass was achieved. Conclusions The case presented here reports an unanticipated process of diffuse large B-cell lymphoma, underlining the importance of interdisciplinary cooperation and surgical intervention within the realms of state-of-the-art treatment.
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Affiliation(s)
- Valerie Wienerroither
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria.
| | - Martin Sauerschnig
- Ludwig Boltzmann Institute for Experimental and Clinical Traumatology in the AUVA Trauma Research Center, Austrian Cluster for Tissue Regeneration, Donaueschingerstraße 13, Vienna, 1200, Austria
| | - Christine Beham-Schmid
- Institute of Pathology, Medical University of Graz, Neue Stiftingtalstraße 6, Graz, 8010, Austria
| | - Erwin Mathew
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Azab El-Shabrawi
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Hans-Jörg Mischinger
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
| | - Peter Kornprat
- Department of General Surgery, Medical University of Graz, Auenbruggerplatz 29, 8036, Graz, Austria
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10
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Skulimowski A, Hogendorf P, Poznańska G, Smolewski P, Strzelczyk J, Durczynski A. Successful hemihepatectomy following chemotherapy for primary liver lymphoma: case report and review of literature. POLISH JOURNAL OF SURGERY 2017; 89:54-58. [PMID: 29154242 DOI: 10.5604/01.3001.0010.5609] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Non-Hodgkin lymphomas (NHL) comprise a heterogeneous group of B-cell and T-cell neoplasms. Diffuse large B-cell lymphoma (DLBCL), the most common type of NHL, accounts for around 30-40% of NHL cases. However, primary hepatic location of NHLs is rare and constitutes 0.01% of all NHL cases. Due to this rarity and a lack of large randomized trails, it is still unclear what treatment should be used for primary hepatic DLBCLs. In this study, we report of a female patient with primary hepatic DLBCL who was successfully treated with neoadjuvant chemotherapy and surgery. We also shortly review the literature regarding surgical treatments for primary GI tract NHLs. Taking into account our experience and the current literature, surgical treatment with postoperative chemotherapy seems to be a feasible option for patients with focal primary hepatic DLBCLs.
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Affiliation(s)
- Aleksander Skulimowski
- Department of General and Transplant Surgery, Barlicki Teaching Hospital, Medical University of Lodz, Lodz, Poland
| | - Piotr Hogendorf
- Department of General and Transplant Surgery, Medical University, Łód
| | - Grażyna Poznańska
- Department of Anaesthesiology and Intensive Therapy, Barlicki University Hospital in Łódź
| | - Piotr Smolewski
- Department of Hematology, Copernicus Memorial Hospital, Medical University of Lodz, Lodz, Poland
| | - Janusz Strzelczyk
- Department of General and Transplant Surgery, Barlicki Teaching Hospital, Medical University of Lodz, Lodz, Poland
| | - Adam Durczynski
- Department of General and Transplant Surgery, Barlicki Teaching Hospital, Medical University of Lodz, Lodz, Poland
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Ikoma N, Badgwell BD, Mansfield PF. Multimodality Treatment of Gastric Lymphoma. Surg Clin North Am 2017; 97:405-420. [DOI: 10.1016/j.suc.2016.11.012] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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12
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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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Di Lorenzo G, De Placido S, Pagliuca M, Ferro M, Lucarelli G, Rossetti S, Bosso D, Puglia L, Pignataro P, Ascione I, De Cobelli O, Caraglia M, Aieta M, Terracciano D, Facchini G, Buonerba C, Sonpavde G. The evolving role of monoclonal antibodies in the treatment of patients with advanced renal cell carcinoma: a systematic review. Expert Opin Biol Ther 2016; 16:1387-1401. [PMID: 27463642 DOI: 10.1080/14712598.2016.1216964] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
INTRODUCTION While the majority of the vascular endothelial growth factor (VEGF) and mammalian target of rapamycin (mTOR) inhibitors currently used for the therapy of metastatic renal cell carcinoma (mRCC) are small molecule agents inhibiting multiple targets, monoclonal antibodies are inhibitors of specific targets, which may decrease off-target effects while preserving on-target activity. A few monoclonal antibodies have already been approved for mRCC (bevacizumab, nivolumab), while many others may play an important role in the therapeutic scenario of mRCC. AREAS COVERED This review describes emerging monoclonal antibodies for treating RCC. Currently, bevacizumab, a VEGF monoclonal antibody, is approved in combination with interferon for the therapy of metastatic RCC, while nivolumab, a Programmed Death (PD)-1 inhibitor, is approved following prior VEGF inhibitor treatment. Other PD-1 and PD-ligand (L)-1 inhibitors are undergoing clinical development. EXPERT OPINION Combinations of inhibitors of the PD1/PD-L1 axis with VEGF inhibitors or cytotoxic T-lymphocyte antigen (CTLA)-4 inhibitors have shown promising efficacy in mRCC. The development of biomarkers predictive for benefit and rational tolerable combinations are both important pillars of research to improve outcomes in RCC.
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Affiliation(s)
- Giuseppe Di Lorenzo
- a Department of Clinical Medicine and Surgery , University Federico II of Naples , Naples , Italy
| | - Sabino De Placido
- a Department of Clinical Medicine and Surgery , University Federico II of Naples , Naples , Italy
| | - Martina Pagliuca
- a Department of Clinical Medicine and Surgery , University Federico II of Naples , Naples , Italy
| | - Matteo Ferro
- b Department of Urology , European Institute of Oncology (IEO) , Milan , Italy
| | - Giuseppe Lucarelli
- c Department of Emergency and Organ Transplantation, Urology, Andrology and Kidney Transplantation Unit , University of Bari , Bari , Italy
| | - Sabrina Rossetti
- d Division of Medical Oncology, Department of Uro-Gynaecological Oncology , Istituto Nazionale Tumori 'Fondazione G. Pascale' - IRCCS , Naples , Italy
| | - Davide Bosso
- a Department of Clinical Medicine and Surgery , University Federico II of Naples , Naples , Italy
| | - Livio Puglia
- a Department of Clinical Medicine and Surgery , University Federico II of Naples , Naples , Italy
| | - Piero Pignataro
- e Dipartimento di Medicina Molecolare e Biotecnologie Mediche , University Federico II of Naples , Naples , Italy
| | - Ilaria Ascione
- a Department of Clinical Medicine and Surgery , University Federico II of Naples , Naples , Italy
| | - Ottavio De Cobelli
- b Department of Urology , European Institute of Oncology (IEO) , Milan , Italy
| | - Michele Caraglia
- f Department of Biochemistry, Biophysics and General Pathology , Second University of Naples , Naples , Italy
| | - Michele Aieta
- g Department of Onco-Hematology, Division of Medical Oncology , Centro di Riferimento Oncologico della Basilicata, IRCCS , Rionero in Vulture (PZ) , Italy
| | - Daniela Terracciano
- h Department of Translational Medical Sciences , University 'Federico II' , Naples , Italy
| | - Gaetano Facchini
- d Division of Medical Oncology, Department of Uro-Gynaecological Oncology , Istituto Nazionale Tumori 'Fondazione G. Pascale' - IRCCS , Naples , Italy
| | - Carlo Buonerba
- a Department of Clinical Medicine and Surgery , University Federico II of Naples , Naples , Italy
| | - Guru Sonpavde
- i University of Alabama at Birmingham (UAB) Comprehensive Cancer Center , Birmingham , AL , USA
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Li X, Wang X, Zhan Z, Zhang L, Sun B, Zhang Y. Evaluation of the clinical characteristics, management, and prognosis of 103 patients with gastric mucosa-associated lymphoid tissue lymphoma. Oncol Lett 2016; 11:1713-1718. [PMID: 26998066 PMCID: PMC4774547 DOI: 10.3892/ol.2016.4124] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 01/18/2016] [Indexed: 01/17/2023] Open
Abstract
The diagnosis of gastric mucosa-associated lymphoid tissue (MALT) lymphoma is difficult owing to its non-specific symptoms and various endoscopic findings. Treatments such as radiotherapy (RT) for localized and chemotherapy (CT) for advanced stages of the disease are employed. The aim of the present study was to examine the clinical characteristics and prognostic factors of Helicobacter pylori (H. pylori) eradication (HPE) in patients with gastric MALT lymphoma. The medical records of 103 patients with gastric MALT lymphoma for the period 2001–2013, were analyzed. The 103 median age of the patients was 53 years and the male to female ratio was 1:1. Serum lactate dehydrogenase and β2-microglobulin were within normal range. Macroscopically, the most commonly involved site was the antrum, followed by the corpus and fundus. A total of 97 patients (94%) tested positive for H. pylori. Forty patients (39%) had stage I, 35 patients (35%) had local or distant nodal involvement, 20 of 103 patients had stage IIIE (19%) and 8 of 103 patients had stage IV (7%) disease. Complete remission, after HPE, was achieved in 54 of the 69 patients (78%) that were H. pylori-positive and in 2 of the 4 patients (50%) that were H. pylori-negative. HPE had a superior trend in the H. pylori-positive patients although no significant difference was identified in the two groups (p=0.194). In patients with advanced disease, the 5-year progression-free survival (PFS) and overall survival (OS) estimates were significantly improoved for patients receiving HPE with CT or RT than those receiving CT or RT (p=0.046 and 0.035, respectively). The multivariate analysis revealed that, the advanced stages were independently associated with shorter PFS, and the modified-International Prognostic Index (m-IPI) (≥2) was associated with shorter OS. In conclusion, gastric MALT lymphoma had a favorable outcome with a high OS rate. HPE was an effective treatment for gastric MALT lymphoma. The patients with advanced stages and m-IPI (≥2) had a much worse prognosis.
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Affiliation(s)
- Xiaowu Li
- Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Xiang Wang
- Department of Medical Oncology, Xuzhou Central Hospital, Xuzhou, Jiangsu 221009, P.R. China
| | - Zhongli Zhan
- Department of Pathology, Tianjin Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Lianyu Zhang
- Department of Pathology, Tianjin Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Baochun Sun
- Department of Pathology, Tianjin Cancer Institute and Hospital, Tianjin 300060, P.R. China
| | - Yizhuo Zhang
- Department of Hematology, Tianjin Cancer Institute and Hospital, Tianjin 300060, P.R. China
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15
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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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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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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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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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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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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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