Retrospective analysis of primary gastric diffuse large B-cell lymphoma: a single center study from Turkey
Retrospective analysis of primary gastric diffuse large B-cell lymphoma: a single center study from Turkey
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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- 1. Kolve M, Fischbach W, Greiner A, Wilms K. Differences in endoscopic and clinicopathological features of primary and secondary gastric non-Hodgkins lymphoma. German Gastrointestinal Lymphoma Study Group. Gastrointest Endosc 1999; 49: 307-315.
- 2. Cortelazzo S, Rossi A, Roggero F, Oldani E, Zucca E, Tondini C, Ambrosetti A, Pasini F, Pinotti G, Bertini M et al. Stagemodified international prognostic index effectively predicts clinical outcome of localized primary gastric diffuse large B-cell lymphoma. International Extranodal Lymphoma Study Group (IELSG). Ann Oncol 1999; 10: 1433-1440.
- 3. Psyrri A, Papageorgiou S, Economopoulos T. Primary extranodal lymphomas of stomach: clinical presentation diagnostic pitfalls and management. Ann Oncol 2008; 19: 1992-1999.
- 4. Ferreri AJ, Montalbán C. Primary diffuse large B-cell lymphoma of the stomach. Crit Rev Oncol Hematol 2007; 63: 65-71.
- 5. Binn M, Ruskoné-Fourmestraux A, Lepage E, Haioun C, Delmer A, Aegerter P, Lavergne A, Guettier C, Delchier JC. Surgical resection plus chemotherapy versus chemotherapy alone: comparisons of two strategies to treat diffuse large B-cell gastric lymphoma. Ann Oncol 2003; 14: 1751-1757.
- 6. Yoon SS, Coit DG, Portlock CS, Karpeh MS. The diminishing role of surgery in the treatment of gastric lymphoma. Ann Surg 2004; 240: 28-37.
- 7. Koch P, Probst A, Berdel WE, Willich NA, Reinartz G, Brockmann J, Liersch R, del Valle F, Clasen H, Hirt C et al. Treatment results in localized primary gastric lymphoma: data of patients registered within the German multicenter study (GIT NHL 02/96). J Clin Oncol 2005; 23: 7050-7059.
- 8. Avilés A, Nambo MJ, Neri N, Huerta-Guzmán J, Cuadra I, Alvarado I, Castañeda C, Fernández R, González M. The role of surgery in primary gastric lymphoma: results of a controlled clinical trial. Ann Surg 2004; 240: 44-50.
- 9. Coiffier B, Lepage E, Briere J, Herbrecht R, Tilly H, Bouabdallah R, Morel P, Van Den Neste E, Salles G, Gaulard P et al. CHOP chemotherapy plus rituximab compared with CHOP alone in elderly patients with diffuse large-B-cell lymphoma. N Engl J Med 2002; 346: 235-242.
- 10. Wöhrer S, Püspök A, Drach J, Hejna M, Chott A, Raderer M. Rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) for treatment of early-stage gastric diffuse large B-cell lymphoma. Ann Oncol 2004; 15: 1086- 1090.
- 11. Avilés A, Castañeda C, Cleto S, Neri N, Huerta-Guzmán J, Gonzalez M, Nambo MJ. Rituximab and chemotherapy in primary gastric lymphoma. Cancer Biother Radiopharm 2009; 24: 25-28.
- 12. Leopardo D, DiLorenzo G, De Renzo A, Federico P, Luponio S, Buonerba C, Matano E, Merola G, Imbimbo M, Montesarchio E et al. Efficacy of rituximab in gastric diffuse large B cell lymphoma patients. World J Gastroenterol 2010; 16: 2526- 2530.
- 13. Kobayashi Y, Hatta Y, Hojo A, Kura Y, Uchino Y, Takahashi H, Kiso S, Hirabayashi Y, Yagi M, Kodaira H et al. 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.
- 14. 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: 1731-1739.
- 15. 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: 2175-2181.
- 16. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, Thiele J, Vardiman JW. WHO Classification of Tumours of Haematopoietic and Lymphoid Tissues. Lyon, France: IARC Press, 2008.
- 17. Rohatiner A, dAmore F, Coiffier B, Crowther D, Gospodarowicz M, Isaacson P, Lister TA, Norton A, Salem P, Shipp M et al. Report on a workshop convened to discuss the pathological and staging classifications of gastrointestinal tract lymphoma. Ann Oncol 1994; 5: 397-400.
- 18. Cheson BD, Horning SJ, Coiffier B, Shipp MA, Fisher RI, Connors JM, Lister TA, Vose J, Grillo-López A, Hagenbeek A et al. Report of an international work shop to standardize response criteria for non-Hodgkins lymphomas. NCI Sponsored International Working Group. J Clin Oncol 1999; 17: 1244.
- 19. Koch P, del Valle F, Berdel WE, Willich NA, Reers B, Hiddemann W, Grothaus-Pinke B, Reinartz G, Brockmann J, Temmesfeld A et al; German Multicenter Study Group. Primary gastrointestinal non-Hodgkins lymphoma: II. Combined surgical and conservative or conservative management only in localized gastric lymphomaresults of the prospective German Multicenter Study GIT NHL 01/92. J Clin Oncol 2001; 19: 3874-3883.
- 20. Hung YS, Lin TL, Kuo MC, Tang TC, Dunn P, Wang PN, Wu JH, Chang H, Kuo TT, Shih LY. Primary gastric diffuse large B-cell lymphoma. Chang Gung Med J 2008; 31: 159-166.
- 21. Kim SJ, Cheong JW, Hahn JS. Therapeutic comparison of chemotherapy and surgery for early stage diffuse large B-cell gastric lymphoma. Yonsei Med J 2007; 48: 942-948.
- 22. Tanaka T, Shimada K, Yamamoto K, Hirooka Y, Niwa Y, Sugiura I, Kitamura K, Kosugi H, Kinoshita T, Goto H et al. Retrospective analysis of primary gastric diffuse large B cell lymphoma in the rituximab era: a multicenter study of 95 patients in Japan. Ann Hematol 2012; 91: 383-390.
- 23. Park YH, Lee SH, Kim WS, Bang SM, Ryoo BY, Yang SH, Lee SS, Kim MS, Kim K, Park KW et al. CHOP followed by involved field radiotherapy for localized primary gastric diffuse large B-cell lymphoma: results of a multi-center phase II study and quality of life evaluation. Leuk Lymphoma 2006; 47: 1253- 1259.
- 24. Ishikura S, Tobinai K, Ohtsu A, Nakamura S, Yoshino T, Oda I, Takagi T, Mera K, Kagami Y, Itoh K et al. Japanese multicenter phase II study of CHOP followed by radiotherapy in stage I-II, diffuse large B-cell lymphoma of the stomach. Cancer Sci 2005; 96: 349-352.
- 25. Sbitti Y, Ismaili N, Bensouda Y, Kadiri H, Ichou M, Errihani H. Management of stage one and two-E gastric large B-cell lymphoma: chemotherapy alone or surgery followed by chemotherapy? J Hematol Oncol 2010; 3: 23.
- 26. Philip T, Guglielmi C, Hagenbeek A, Somers R, Van der Lelie H, Bron D, Sonneveld P, Gisselbrecht C, Cahn JY, Harousseau JL et al. Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapysensitive non-Hodgkins lymphoma. N Engl J Med 1995; 333: 1540-1545.
- 27. Gisselbrecht C, Glass B, Mounier N, Singh Gill D, Linch DC, Trneny M, Bosly A, Ketterer N, Shpilberg O, Hagberg H et al. Salvage regimens with autologous transplantation for relapsed large B-cell lymphoma in the rituximab era. J Clin Oncol 2010; 28: 4184-4190.