Complications and outcomes in diffuse large B‐cell lymphoma with gastric lesions treated with R‐CHOP

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.

<p>Switching Fractioned R-CHOP Cycles to Standard R-CHOP Cycles Guided by Endoscopic Ultrasonography in Treating Patients with Primary Gastric Diffuse Large B-Cell Lymphoma</p>

“…Full cycles of standard R-CHOP (Rituximab d0, 100% dose of CHOP d2) had the risk of severe bleeding or perforation, potentially leading to emergency surgery, especially for those with large and deep lesions in their first 1-2 cycles of treatment. [14][15][16][17] It is known that dose intensity of chemotherapy is crucial in the treatment of lymphoma. As it is defined as the average weekly dose of chemotherapy drugs per square meter of body surface area in the whole treatment course, we fractioned conventional R-CHOP to day one and day five in order not to reduce patients' dose-intensity.…”

Gastric Diffuse Large B-Cell Lymphoma: A Single-Center 9-Year Experience

“…This study adds to the limited number of reports on gastric DLBCL in European populations, contributing to a better understanding of the patient profile and disease biology. Comparatively to coh orts from oriental countries, this population had older patients, higher proportion of females, more advanced disease stage at diagnosis and less surgical interventions [ 19 , 20 ]. We may conclude that gastric DLBCL is a highly curable disease with R-CHOP- like regimens.…”

Complicaciones quirúrgicas del linfoma con compromiso gastrointestinal

“…Clínicamente, la mayoría de los pacientes presentan epigastralgia, dispepsia, hematemesis y melenas. Aproximadamente, el 20 a 30 % de los DLBCL gástricos se presentan con sangrado 35,36 .…”

“…Hasta el 71 % de los sangrados gástricos se presentan durante el primer ciclo de quimioterapia y usualmente se resuelve con manejo endoscópico. La gastrectomía en estos pacientes no mejora la supervivencia, aunque en ocasiones es necesaria para el control del sangrado 36 .…”