Long-term follow-up of localized, primary gastric diffuse large B-cell lymphoma treated with rituximab and CHOP

Abstract

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.

Retrospective analysis of primary gastric diffuse largeB-cell lymphoma: a single center study from Turkey

“…In this study, female predominance was documented, which was consistent with reports from Far East countries although literature from western countries reported male predominance (4,5,12,13,(19)(20)(21).…”

“…In only one study on patients at all stages were 5-year OS (100% versus 63.3%) and DFS (100% versus 73.3%) lower in patients treated without rituximab (12). In a study by Kobayashi et al, 5-year OS of 100% was reported in early-stage patients treated with R-CHOP (13). In the light of these findings, there is a discrepancy about the impact of rituximab on OS and DFS in both early-and late-stage diseases.…”

Primary gastric diffuse large B-cell lymphoma: The role of dose-dense chemotherapy

“…9,10,13,14,15 Thus, it is very difficult to draw any specific factors that can define a better treatment in this type of neoplasm. PG-DLBCL, at early stage, is generally sensitive to standard chemotherapy, because > 90% can achieve CR; 2,3,11 however, relapse can occur in 20–35%, and in most require aggressive salvage treatments.…”

“…1 Actually, the combination of chemotherapy with an anthracycline-based treatment offers the possibility of complete response (CR) in > 90% of patients, with an overall survival (OS) of 76-90% at 5 years. 2,3 Although early stages (I-II) have been considered of good prognosis, a small proportion of cases could have a worse prognosis, and are at risk to relapse, that will need aggressive chemotherapy, including stem cell transplant. However, no specific prognostic factors have been identified including the International Prognostic Index (IPI), because most patients were at low-or low-intermediate clinical risk and will be considered as low risk; other factors such as deep of invasion, tumor burden, lymph node invasion, and molecular profile have not been validated.…”

“…1 Actually, the combination of chemotherapy with an anthracycline-based treatment offers the possibility of complete response (CR) in > 90% of patients, with an overall survival (OS) of 76–90% at 5 years. 2,3…”