Safety and efficacy of low-dose pre-phase before conventional-dose chemotherapy for ulcerative gastric diffuse large B-cell lymphoma

Abstract

Potentially fatal chemotherapy (CT)-related gastrorrhagia and gastric perforation in patients with gastric lymphoma present difficult problems to doctors. We retrospectively analyzed 54 patients with ulcerative gastric diffuse large B-cell lymphoma (G-DLBCL) to compare the safety and efficacy of low-dose pre-phase CT before 4-6 cycles of conventional-dose CT (n = 28) with 4-6 cycles of conventional-dose CT (n = 26) between October 2005 and August 2014. Patients who received low-dose pre-phase before conventional-dose CT showed a lower gastrorrhagia or gastric perforation rate (0% vs. 15.4%, p = 0.047) and higher complete response (CR) rate (78.6% vs. 46.2%, p = 0.023) and 5-year progression-free survival (PFS) rate (63% vs. 31%, p = 0.021) than patients who received conventional-dose CT alone. Our study suggests that low-dose pre-phase therapy before conventional-dose CT provides a safe and effective method for ulcerative G-DLBCL.

A retrospective study on prephase therapy prior to definitive multiagent chemotherapy in aggressive lymphomas

“…Additionally, our study focused predominantly on a chemotherapy-free prephase regimen, with 17 of 22 (77%) patients receiving prednisone alone. While our findings are in-line with previously reported results, these studies have focused on prephase regimens that include chemotherapy [2][3][4].…”

Role of prephase treatment prior to definitive chemotherapy in patients with diffuse large B‐cell lymphoma

“…ECOG performance status >2 is contraindication to give full‐dose R‐CHOP, only if it persists after prephase, which is rare . A Chinese study, which used vincristine 1 mg and cyclophosphamide 200 mg before definitive chemotherapy in gastric DLBCL patients, reported significant improvement in 5 years progression‐free survival rate (63% vs 31%, P = .021) apart from the reduction in immediate toxicities . Another important aspect of prephase treatment more relevant for developing countries is the cost‐effectiveness.…”

“…10 A Chinese study, which used vincristine 1 mg and cyclophosphamide 200 mg before definitive chemotherapy in gastric DLBCL patients, reported significant improvement in 5 years progression-free survival rate (63% vs 31%, P = .021) apart from the reduction in immediate toxicities. 11 Another important aspect of prephase treatment more relevant for developing countries is the cost-effectiveness. The cost of vincristine and prednisolone is minimal as compared to the cost of hospitalization, antibiotics, and growth factor.…”

Development and internal validation of a risk scoring system for gastrointestinal events requiring surgery in gastrointestinal lymphoma patients

“…In contrast, low‐risk patients (score 0), who accounted for half of all GI lymphoma patients, had a low frequency of GI events. Low‐dose pre‐phase chemotherapy can be recommended for intermediate‐risk patients (score 1–2).…”

“…In that study, the small bowel was the most common site of perforation, but this was not evaluated statistically. Regarding macroscopic findings, in patients with gastric lymphoma, the presence of large ulcerative lesions is a risk factor for gastric perforation, but these studies were case series and lacked any statistical analysis . The FDG‐PET SUVmax value could be predictive of GI events because it reflects the activity of lymphoma, but the association has not been investigated.…”