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ASSESSING THE RISK FOR PERFORATION IN DIFFUSE LARGE B-CELL LYMPHOMA INVOLVING THE INTESTINES USING COMPUTED TOMOGRAPHY CHARACTERISTICS.
Author(s):
Nadav Sarid
,
Nadav Sarid
Affiliations:
Tel-Aviv Sourasky Medical Center,Tel-Aviv,Israel
Adi Sherban
,
Adi Sherban
Affiliations:
Tel-Aviv Sourasky Medical Center,Tel-Aviv,Israel
Udi Bendet
,
Udi Bendet
Affiliations:
Tel-Aviv Sourasky Medical Center,Tel-Aviv,Israel
Efrat Luttwak
,
Efrat Luttwak
Affiliations:
Tel-Aviv Sourasky Medical Center,Tel-Aviv,Israel
Yair Herishanu
,
Yair Herishanu
Affiliations:
Tel-Aviv Sourasky Medical Center,Tel-Aviv,Israel
Chava Perry
,
Chava Perry
Affiliations:
Tel-Aviv Sourasky Medical Center,Tel-Aviv,Israel
Irit Avivi
Irit Avivi
Affiliations:
Tel-Aviv Sourasky Medical Center,Tel-Aviv,Israel
(Abstract release date: 05/18/17) EHA Library. Sarid N. 05/18/17; 182439; PB1725
Nadav Sarid
Nadav Sarid
Contributions
PDF Abstract
Abstract

Abstract: PB1725

Type: Publication Only

Background
Around 40% of all Diffuse Large B-Cell Lymphoma (DLBCL) cases involve extra-nodal sites, the most common being the gastro-intestinal (GI) tract. DLBCL patients with intestinal involvement are particularly prone to develop GI perforation, which might be life threatening and entail significant morbidity. Identification of patients at risk for perforation may promote the performance of pre-emptive surgical resection of the involved segment. Although computed tomography (CT) scan is widely used at diagnosis, incorporation of CT results into the risk stratification of perforation has not yet been performed.

Aims
To determine risk factors for perforation in patients with DLBCL and intestinal involvement, with an emphasis on CT findings.

Methods

A retrospective single center study, including all consecutive DLBCL patients that presented with intestinal involvement between 2005 and 2016. The analysis included clinical, laboratory, pathological and radiological parameters. Cases with DLBCL of the stomach were excluded.

Results

Forty-nine cases (30 men, 19 women) were included. Median age of the entire cohort was 64 years (54.5-77 IQR). Early stage (1, 2) according to the Lugano system was reported in 35% of cases. Small intestine involvement was most frequent (61%), followed by large intestine and ilio-cecum (23 and 16%, respectively).
Forty-three (88%) patients underwent CT scan at diagnosis. Most lesions were defined radiology as concentric (n=27, 63%) (as opposed to eccentric), and transmural (n=31, 74%) (as opposed to non-transmural). Of note, 96.3% of the 27 concentric lesions were also transmural, compared with 31% (5/16) of the eccentric lesions. The median length and wall thickness of the involved site were 9.3 cm (5.8-13.5) and 15 mm (10-20), respectively.
Ten (20%) patients developed an intestinal perforation. Six of the perforations (60%) involved the small intestine, 3 (33%) occurred at diagnosis prior chemotherapy, and 4 (40%) occurred within the first 21 days post therapy. All perforated lesions were concentric and transmural, with a median length of 11.2 cm.
Eight (80%) patients underwent an urgent operation due to GI perforation, including 3 that resulted in an ostomy. Perforation led directly to 2 (20%) deaths. Perforation resulted in delayed administration of chemotherapy in 50% of cases (n=5).
A univariate regression analysis found a higher risk of perforation in patients presenting with a concentric lesion (p=0.001. HR=46, CI 31.5-78.5), a transmural lesion (p=0.001. HR=34.6, CI 25.9-53.3) and a longer involved GI segment (p=0.008. HR=1.06, CI 1.017-1.116). Each extra centimeter to the length of the GI segment involved was associated with a 6% increase in the risk for perforation. There was no association between sex, age, performance status, hemoglobin, LDH, albumin, iron, ferritin, KI67, disease stage, anatomical location nor the involved site wall thickness and risk of perforation.

Conclusion

DLBCL patients presenting with an involvement of a long intestinal segment, especially with a concentric, transmural lesion, are at higher risk for perforation. These patients should be considered for a preemptive surgical resection, dependent on lesion site and operative risk.

Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): Risk factor, Extranodal lymphoma, DLBCL, Complications

Abstract: PB1725

Type: Publication Only

Background
Around 40% of all Diffuse Large B-Cell Lymphoma (DLBCL) cases involve extra-nodal sites, the most common being the gastro-intestinal (GI) tract. DLBCL patients with intestinal involvement are particularly prone to develop GI perforation, which might be life threatening and entail significant morbidity. Identification of patients at risk for perforation may promote the performance of pre-emptive surgical resection of the involved segment. Although computed tomography (CT) scan is widely used at diagnosis, incorporation of CT results into the risk stratification of perforation has not yet been performed.

Aims
To determine risk factors for perforation in patients with DLBCL and intestinal involvement, with an emphasis on CT findings.

Methods

A retrospective single center study, including all consecutive DLBCL patients that presented with intestinal involvement between 2005 and 2016. The analysis included clinical, laboratory, pathological and radiological parameters. Cases with DLBCL of the stomach were excluded.

Results

Forty-nine cases (30 men, 19 women) were included. Median age of the entire cohort was 64 years (54.5-77 IQR). Early stage (1, 2) according to the Lugano system was reported in 35% of cases. Small intestine involvement was most frequent (61%), followed by large intestine and ilio-cecum (23 and 16%, respectively).
Forty-three (88%) patients underwent CT scan at diagnosis. Most lesions were defined radiology as concentric (n=27, 63%) (as opposed to eccentric), and transmural (n=31, 74%) (as opposed to non-transmural). Of note, 96.3% of the 27 concentric lesions were also transmural, compared with 31% (5/16) of the eccentric lesions. The median length and wall thickness of the involved site were 9.3 cm (5.8-13.5) and 15 mm (10-20), respectively.
Ten (20%) patients developed an intestinal perforation. Six of the perforations (60%) involved the small intestine, 3 (33%) occurred at diagnosis prior chemotherapy, and 4 (40%) occurred within the first 21 days post therapy. All perforated lesions were concentric and transmural, with a median length of 11.2 cm.
Eight (80%) patients underwent an urgent operation due to GI perforation, including 3 that resulted in an ostomy. Perforation led directly to 2 (20%) deaths. Perforation resulted in delayed administration of chemotherapy in 50% of cases (n=5).
A univariate regression analysis found a higher risk of perforation in patients presenting with a concentric lesion (p=0.001. HR=46, CI 31.5-78.5), a transmural lesion (p=0.001. HR=34.6, CI 25.9-53.3) and a longer involved GI segment (p=0.008. HR=1.06, CI 1.017-1.116). Each extra centimeter to the length of the GI segment involved was associated with a 6% increase in the risk for perforation. There was no association between sex, age, performance status, hemoglobin, LDH, albumin, iron, ferritin, KI67, disease stage, anatomical location nor the involved site wall thickness and risk of perforation.

Conclusion

DLBCL patients presenting with an involvement of a long intestinal segment, especially with a concentric, transmural lesion, are at higher risk for perforation. These patients should be considered for a preemptive surgical resection, dependent on lesion site and operative risk.

Session topic: 20. Aggressive Non-Hodgkin lymphoma - Clinical

Keyword(s): Risk factor, Extranodal lymphoma, DLBCL, Complications

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