Wöhrer Stefan, Bartsch Rupert, Hejna Michael, Drach Johannes, Raderer Markus
Department of Medicine I, Medical University Vienna, Austria.
Scand J Gastroenterol. 2005 Oct;40(10):1222-5. doi: 10.1080/00365520510023440.
The stomach is the most common site of origin for extranodal lymphomas. While resection has played a major part in the management of such patients in the past, in recent years there has been a change towards organ-conserving therapies. However, the risk of perforation and bleeding in patients undergoing organ-conserving therapy has been used as an argument against primary application of chemotherapy. In this article, we present our experience with the prophylactic use of oral pantoprazole.
All patients undergoing chemotherapy for gastric lymphoma at our institution were prophylactically given oral pantoprazole (2x40 mg) for the duration of chemotherapy. Compliance with intake of the proton-pump inhibitor (PPI) was assessed at every visit for application of chemotherapy and at routine blood counts taken 10-14 days after each cycle of treatment by direct questioning of the patient.
A total of 82 patients (median age 69 years, range 33-93) received chemotherapy for gastric lymphoma: 51 had diffuse large B-cell lymphoma (DLBCL), 24 had mucosa-associated lymphoid tissue (MALT) lymphoma and 7 had DLBCL+MALT lymphoma. Compliance with intake of the PPI was excellent, as only two patients reported irregular intake and only one patient refused regular medication with pantoprazople. All patients responded to chemotherapy, with 74 (90%) achieving complete remission and 8 (10%) partial remission. After a median follow-up time of 50 months (range: 9-84 months) only one of these 82 patients (1.22%), the patient who discontinued intake of pantoprazole, died from gastric perforation, while none of the other patients had gastrointestinal bleeding or perforation.
Judging from these data, continuous PPI intake is feasible and has a high rate of compliance. In the absence of randomized trials, routine application of oral pantoprazole in patients given chemotherapy for gastric lymphoma, especially DLBCL, appears to be a reasonable approach.
胃是结外淋巴瘤最常见的起源部位。过去，手术切除在这类患者的治疗中发挥了主要作用，但近年来，治疗方式已转向器官保留疗法。然而，接受器官保留疗法的患者发生穿孔和出血的风险被用作反对化疗一线应用的理由。在本文中，我们介绍了口服泮托拉唑预防性使用的经验。
在我们机构接受胃淋巴瘤化疗的所有患者在化疗期间均预防性给予口服泮托拉唑（2×40毫克）。在每次化疗就诊时以及每个治疗周期后10 - 14天进行常规血常规检查时，通过直接询问患者来评估质子泵抑制剂（PPI）的服用依从性。
共有82例患者（中位年龄69岁，范围33 - 93岁）接受胃淋巴瘤化疗：51例为弥漫性大B细胞淋巴瘤（DLBCL），24例为黏膜相关淋巴组织（MALT）淋巴瘤，7例为DLBCL + MALT淋巴瘤。PPI的服用依从性极佳，因为只有两名患者报告服药不规律，只有一名患者拒绝规律服用泮托拉唑。所有患者对化疗均有反应，74例（90%）实现完全缓解，8例（10%）部分缓解。中位随访时间50个月（范围：9 - 84个月）后，这82例患者中只有1例（1.22%），即停止服用泮托拉唑的患者，死于胃穿孔，而其他患者均未发生胃肠道出血或穿孔。
从这些数据来看，持续服用PPI是可行的，且依从率很高。在缺乏随机试验的情况下，对于接受胃淋巴瘤化疗的患者，尤其是DLBCL患者，常规应用口服泮托拉唑似乎是一种合理的方法。
