Division of Gastroenterology, Department of Internal Medicine, Hiroshima Red Cross Hospital & Atomic-bomb Survivors Hospital, Hiroshima, Japan.
Department of Health and Science, Prefectural University of Hiroshima, Hiroshima, Japan.
J Gastroenterol Hepatol. 2018 Aug;33(8):1461-1468. doi: 10.1111/jgh.14100. Epub 2018 Mar 25.
Few reports have demonstrated the effectiveness of treatments for intestinal follicular lymphoma (FL) because of the limited number of patients who undergo comprehensive small intestinal examinations. This study compared the efficacy of rituximab-combined chemotherapy in patients with asymptomatic and low tumor burden (LTB) intestinal FL, according to the criteria of the Groupe d'Etude des Lymphomes Folliculaires, with that of a "watch and wait" (W&W) approach.
The endoscopic examination for entire gastrointestinal tracts was performed in 29 Japanese patients with intestinal FL. These patients had CD21-positive follicular dendritic cells arranged in a duodenal pattern. In a prospective, two-center, open-label trial, this study evaluated the efficacy of rituximab-combined chemotherapy ([cyclophosphamide, doxorubicin, vincristine, and prednisone] or [cyclophosphamide, vincristine, and prednisone]) and prolonged treatment with rituximab (R-Chemo+prolongedR) in 14 patients and compared their outcomes with those of 15 patients managed with a W&W approach.
Four patients managed with the W&W plan showed worsening macroscopic findings, lesion area enlargement, or clinical stage progression but stayed on this plan because they had LTB and experienced no changes in bowel function. In the R-Chemo+prolongedR group, all patients achieved complete remission; recurrence occurred in one patient, who was subsequently managed with the W&W plan because of LTB. There were no significant differences in progression-free survival between the two groups (P = 0.1045). Overall survival was 100% in both groups.
The prognoses of patients with asymptomatic intestinal FL and LTB who were managed with a W&W strategy were comparable with those of patients receiving R-Chemo+prolongedR.
由于接受全面小肠检查的患者数量有限，因此很少有报道显示治疗肠道滤泡淋巴瘤（FL）的疗效。本研究根据 Groupe d'Etude des Lymphomes Folliculaires 的标准，比较了利妥昔单抗联合化疗治疗无症状和低肿瘤负担（LTB）肠道 FL 患者的疗效与“观察等待”（W&W）方法。
对 29 例肠道 FL 日本患者进行了整个胃肠道的内镜检查。这些患者的 CD21 阳性滤泡树突状细胞呈十二指肠样排列。在一项前瞻性、双中心、开放标签试验中，本研究评估了利妥昔单抗联合化疗（[环磷酰胺、多柔比星、长春新碱和泼尼松]或[环磷酰胺、长春新碱和泼尼松]）和利妥昔单抗延长治疗（R-Chemo+prolongedR）在 14 例患者中的疗效，并将其结果与 15 例接受 W&W 方案治疗的患者进行比较。
在 W&W 方案中，有 4 例患者的宏观表现恶化、病变面积扩大或临床分期进展，但仍留在该方案中，因为他们的肿瘤负担较低，且没有出现肠道功能变化。在 R-Chemo+prolongedR 组中，所有患者均达到完全缓解；1 例患者复发，由于 LTB 而采用 W&W 方案进行治疗。两组的无进展生存率无显著差异（P=0.1045）。两组的总生存率均为 100%。
对于无症状肠道 FL 和 LTB 患者，采用 W&W 策略治疗的患者与接受 R-Chemo+prolongedR 治疗的患者的预后相当。
