Guarnera Luca, Meconi Federico, Secchi Roberto, Pascale Maria Rosaria, Esposito Fabiana, Zizzari Annagiulia, Rapisarda Vito Mario, Rizzo Manuela, Pupo Livio, Cantonetti Maria
Hematology, Department of Biomedicine and Prevention, Tor Vergata University, Rome, Italy.
Mediterr J Hematol Infect Dis. 2022 Mar 1;14(1):e2022017. doi: 10.4084/mjhid.2022.017. eCollection 2022.
Gastric Diffuse large B-cell lymphoma (DLBCL) is the most common extranodal site of lymphoma's involvement (30%-40% of all extranodal lymphomas and 55%-65% of all gastrointestinal lymphomas). However, gastric localizations are also sometimes found in systemic DLBCL. Gastric complications such as bleeding, perforation, and stenosis under chemotherapy are well documented.
We retrospectively analyzed 15 patients with newly diagnosed DLBCL with gastrointestinal involvement. Endoscopies were performed in these patients before and after treatment. Treatment consisted of cyclophosphamide low-dose pre-phase chemotherapy before conventional-dose chemotherapy.
Endoscopy at staging detected ulcers in 12 patients (80%). After low-dose pre-phase chemotherapy, GI ulcers healed in 91.6% of cases (1 ulcer detected). After the whole treatment (Low-dose pre-phase + chemotherapy) 9 patients (60%) achieved complete response, 4 patients (26.6%) partial response, 2 (13,3%) patients presented disease progression. The most frequent adverse event was neutropenia (73.3%); the most frequent non-hematological adverse event was transaminases elevation (20%).
Cyclophosphamide low-dose pre-phase chemotherapy resulted in a safe and effective way to prevent adverse events in systemic DLBCL with gastrointestinal involvement.
胃弥漫性大B细胞淋巴瘤（DLBCL）是淋巴瘤最常见的结外受累部位（占所有结外淋巴瘤的30%-40%，所有胃肠道淋巴瘤的55%-65%）。然而，在系统性DLBCL中有时也会发现胃部受累情况。化疗期间出现的诸如出血、穿孔和狭窄等胃部并发症已有充分记录。
我们回顾性分析了15例新诊断的伴有胃肠道受累的DLBCL患者。在这些患者治疗前后均进行了内镜检查。治疗包括在常规剂量化疗前进行低剂量环磷酰胺预化疗阶段。
分期时的内镜检查发现12例患者（80%）有溃疡。低剂量预化疗阶段后，91.6%的病例（仅检测到1处溃疡）胃肠道溃疡愈合。整个治疗（低剂量预化疗阶段+化疗）后，9例患者（60%）达到完全缓解，4例患者（26.6%）部分缓解，2例患者（13.3%）疾病进展。最常见的不良事件是中性粒细胞减少（73.3%）；最常见的非血液学不良事件是转氨酶升高（20%）。
低剂量环磷酰胺预化疗阶段是预防伴有胃肠道受累的系统性DLBCL不良事件的一种安全有效的方法。
