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.
BACKGROUND: Habitual consumption of green tea has been epidemiologically correlated with low risk of cancer. Among various constituents of green tea, catechins are experimentally suggested to have benefitial activity. Especially, (-)-epigallocatechin gallate (EGCG) is the most bioactive constituent. Decreased activation of carcinogenic compounds by inhibition CYP3A4 is proposed as one of mechanisms of anticarcinogenic effect. Green tea is one of the most popular beverages in Japan and Asian countries, and patients often take drugs with green tea beverages. Co-administration of oral cancer medicine which is metabolized by CYP3A4 with green tea may cause harmful interactions. PURPOSE: We investigated the effect of green tea beverage intake on pharmacokinetics of etoposide in an open label, single-dose, randomized, two-way crossover study. METHODS: Patients with various cancers were randomly assigned to receive an etoposide 50-mg capsule either with 600mL green tea beverage or 600mL of water, separated by at least 72-hours washout period. Blood samples were collected for 24 hours. Etoposide concentrations in plasma were determined by high performance liquid chromatography. Plasma pharmacokinetic parameters, including area under the curve (AUC), maximum concentration (Cmax) and elimination half-life (t1/2) were calculated by non-compartment analysis using WinNonlin software. RESULTS: Twenty-five cancer patients (11 males, 14 females; median (range) age, 63 years (46 to 81 years)) participated in this study. Co-administration with green tea resulted in an unexpected decrease by 24.8% in the AUC (p= 0.0003) of etoposide (Table). Carry-over effect was denied. CONCLUSION: Green tea reduces rather than increases exposure to orally administered etoposide.Mean pharmacokinetic parameters of etoposideParameters Water Green teaP-valueAUC 337.61257.45P=0.0003(mg*min/ml) Cmax (mcg/ml) 2.97252.1284P=0.0004t1/2 (h) 7.43116.7696P=0.0771 Citation Format: {Authors}. {Abstract title} [abstract]. In: Proceedings of the 101st Annual Meeting of the American Association for Cancer Research; 2010 Apr 17-21; Washington, DC. Philadelphia (PA): AACR; Cancer Res 2010;70(8 Suppl):Abstract nr 2600.
Background Lenalidomide, an analogue of thalidomide, is frequently used to treat multiple myeloma (MM). Progressive multifocal leukoencephalopathy (PML) is an infectious disease of the central nervous system caused by the reactivation of the JC polyomavirus. Only a few reports have described PML in patients receiving lenalidomide therapy. Case presentation A 76‐year‐old man with MM presented progressive visual and cognitive impairment during lenalidomide administration. Magnetic resonance imaging showed a lesion in the right parietal lobe. Brain biopsy confirmed the diagnosis of PML. Lenalidomide therapy was discontinued, and oral mefloquine was commenced. He was alive more than 1 year later with mild neurologic decline. Conclusions Although rare, lenalidomide‐induced PML should be considered in myeloma patients treated with lenalidomide.
Background: The standard therapy for primary gastric diffuse large B-cell lymphoma (DLBCL) is chemotherapy of R-CHOP with/without involved-field radiation therapy. Although some reports indicated that gastrointestinal complications after chemotherapy for DLBCL occur at a rate of 0-26%, little is known about riskfactors for the complications. In addition, to detect DLBCL in gastric lesion, both of positron emission tomography-computed tomography (PET-CT) and esophagogastroduodenoscopy (EGD) are useful tools. However, there have been few reports comparing them. The aim of this study is to show the outcomes including treatment-related complications in patients with gastric DLBCL and risk factors for the gastric complications. Moreover, we evaluated whether PET-CT is sufficient to detect DLBCL in gastric lesion by comparing with EGD. Patients and methods: This retrospective study included consecutive patients with newly diagnosed DLBCL between October 2003 and July 2014 who underwent EGD and were treated with R-CHOP in our hospital. We classified the patients into three groups. Group A-1: patients who had documented DLBCL in gastric lesion by EGD and underwent PET-CT; group A-2: patients who had documented DLBCL in gastric lesion by EGD and did not underwent PET-CT; group B: patients who had no documented DLBCL in gastric lesion by EGD and underwent PET-CT. Suspected lymphomatous lesions by EGD were biopsied and immunopathologically examined. Gastric DLBCL was defined only when pathologically confirmed. In PET-CT, gastric lesions with SUV max ≥ 5 were considered positive. Outcomes and risk factors for complications among group A were analyzed using the logistic regression model. We evaluated significance of PET-CT and EGD in group A-1 and B by the positive predictive value (PPV) and the negative predictive value (NPV). Results: Among 448 patients diagnosed with DLBCL, 178 patients were enrolled for our study: 55 in group A-1, 28 in group A-2 and 95 in group B. Among 83 patients with gastric DLBCL (group A), the median age was 69 years (range, 29-85). The numbers of patients with clinical stage (Ann Arbor classification) I, II, III, and IV were 27, 18, 5, and 33, respectively. The rate of complete remission was 87%, and the median 3- and 5-year over survival (OS) were 81% and 75%, respectively. The median 3-year OS of patients with very good, good, and poor grade of Revised International Prognostic Index (R-IPI) was 100%, 77%, and 63%, respectively (Figure, p=0.025). Ten patients had gastric complications: 6 with bleeding that needed blood transfusion and 3 with gastrointestinal stenosis defined as ordinary endoscopy could not pass, no patients had gastrointestinal perforation. Most of bleeding (66.7%) occurred during the first cycle of R-CHOP (median, 15 days; range, 1-206). A multivariate analysis showed that low serum albumin (ALB) at diagnosis was an independent risk factor for gastric complications (odds ratio 10.75, p <0.001). The numbers of patients with positive or negative results examined by PET-CT or EGD in group A-1 and B were shown in Table. PPV and NPV of PET-CT were 0.90 and 0.97, respectively. Conclusions: The present study showed that R-IPI was also predictive of survival in gastric DLBCL and low ALB at diagnosis as a significant risk factor for gastric complications following R-CHOP. In addition, our data suggested that PET-CT may be sufficient in the role of detecting gastric lesion of DLBCL because of high PPV and NPV. Disclosures No relevant conflicts of interest to declare.
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