Saito Makoto, Mori Akio, Tsukamoto Shihori, Ishio Takashi, Yokoyama Emi, Izumiyama Koh, Morioka Masanobu, Kondo Takeshi, Sugino Hirokazu
Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Japan.
Department of Cancer Pathology, Hokkaido University, Faculty of Medicine, Sapporo 060-8638, Japan.
World J Gastrointest Oncol. 2022 Aug 15;14(8):1552-1561. doi: 10.4251/wjgo.v14.i8.1552.
Duodenal-type follicular lymphoma (D-FL) has been recognized as a rare entity that accounts for approximately 4% of primary gastrointestinal lymphomas. D-FL follows an indolent clinical course compared with common nodal FL and is generally considered to have a better prognosis. Therefore, the "watch and wait" approach is frequently adopted as the treatment method. Alternatively, there is an option to actively intervene in D-FL. However, the long-term outcomes of such cases are poorly understood.
To clarify the clinical outcomes after long-term follow-up in cases of D-FL with treatment intervention.
We retrospectively analyzed patients who met the following criteria: the lesion was confirmed by endoscopy, the diagnosis of D-FL was confirmed histopathologically, and the patient was followed-up for more than 10 years after the intervention at our center.
We identified 5 cases of D-FL. Two patients showed a small amount of bone marrow involvement (Stage IV). Rituximab was used as a treatment for remission in all 5 patients. It was also used in combination with chemotherapy in 2 Stage IV patients as well as for maintenance treatment. Radiation therapy was performed in 2 cases, which was followed by complete remission (CR). Eventually, all 5 patients achieved CR and survived for more than 10 years. However, 3 patients experienced recurrence. One patient achieved a second CR by retreatment, and in another case, the lesion showed spontaneous disappearance. The remaining patient had systemic widespread recurrence 13 years after the first CR. Biopsy results suggested that the FL lesions were transformed into diffuse large B-cell lymphoma. The patient died 4 years later despite receiving various chemotherapies.
In this study, the treatment for patients of D-FL in Stage IV was successful. In the future, criteria for how to treat "advanced" D-FL should be established based on additional cases. This study of patients with D-FL indicates that whole-body follow-up examinations should continue for a long time due to a fatal recurrence 13 years after reaching CR.
十二指肠型滤泡性淋巴瘤（D-FL）已被确认为一种罕见实体，约占原发性胃肠道淋巴瘤的4%。与常见的淋巴结滤泡性淋巴瘤相比，D-FL临床病程惰性，一般认为预后较好。因此，“观察等待”方法常被用作治疗手段。另外，也有对D-FL进行积极干预的选择。然而，此类病例的长期结局了解甚少。
阐明经治疗干预的D-FL病例长期随访后的临床结局。
我们回顾性分析了符合以下标准的患者：病变经内镜检查确诊，D-FL诊断经组织病理学证实，且患者在本中心干预后随访超过10年。
我们确定了5例D-FL患者。2例患者有少量骨髓受累（IV期）。所有5例患者均使用利妥昔单抗治疗以实现缓解。2例IV期患者还将其与化疗联合使用以及用于维持治疗。2例患者接受了放射治疗，随后完全缓解（CR）。最终，所有5例患者均实现CR并存活超过10年。然而，3例患者复发。1例患者经再次治疗实现第二次CR，另一例患者病变自发消失。其余1例患者在首次CR后第13年出现全身广泛复发。活检结果提示FL病变转化为弥漫性大B细胞淋巴瘤。尽管接受了各种化疗，该患者4年后死亡。
在本研究中，IV期D-FL患者的治疗是成功的。未来，应根据更多病例制定如何治疗“晚期”D-FL的标准。对D-FL患者的这项研究表明，由于在达到CR后13年出现致命复发，应长期持续进行全身随访检查。
