Contributions
Abstract: PB1452
Type: Publication Only
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Primary gastric lymphoma (PGL) is a rare disease. It is, however, the most common extra nodal non-Hodgkin lymphoma (NHL). Diffuse large B cell lymphoma (DLBCL) is the common aggressive subtype of gastric NHL.
Aims
The purpose of our study is to analyze its epidemiological aspects, clinical features, endoscopic aspects, therapeutic methods and prognostic factors in our center.
Methods
This retrospective study involved untreated patients with primary gastric large B cell lymphoma diagnosed between January 2006 and December 2019 in the hematology department of Sfax in Tunisia. The Musshoff-modified Ann Arbor System was used for clinical staging. We used the Revised International Prognostic index (R-IPI) score to evaluate prognosis.Patients were treated with chemotherapy (CHOP+/-R, ACVBP+/- R or mini CEOP/CHOP +/- R) alone or followed by radiation or autologous stem cell transplantation. The International Working Group Response Criteria for NHL 1999 was used to evaluate the response. To confirm complete remission, gastric lesions were evaluated by Endoscopy combined to Biopsy. Kaplan-Meier method was used to estimate overall survival (OS) and event free survival (EFS).
Results
A total of 24 eligible patients were identified. Sex ratio was 1.2.Median age was 59 years (17-82). The mean consultation delay was 9 months (1-48 months). Epigastric abdominal pain was the most common revealing symptom (83% of patients), it was associated to B symptoms in 75% of the cases. Performance Status of 2 or greater was noted in eight patients (33%). In Endoscopy, lesions were found more in gastric body and antrum (25%), there were 1 patient who had multiple located lesions and 1 who had diffuse gastric lesions. One patient had stenosis. Nasopharyngeal biopsy was performed on 10 patients and was positive in one case. Elevated LDH level were observed in 5 patients (21 %). 63% of the patients had localized disease (IE or IIE). Half of the patients were screened for Helicobacter Pylori Infection, it was present in 7 patients (58%). A quarter of gastric DLBCL were associated to low-grade mucosa associated lymphoid tissue (MALT) lymphoma. R-IPI was high in 12% of the cases, intermediate in 71% and low in 17%. The Median follow up was 120 months. One patient died of hemorrhagic shock before treatment and 4 patients died while undergoing chemotherapy. The treatment response was determined in 18 patients, among them:71% achieved complete remission, 24% were evaluated partial response and 5% were in progression. Five Years OS and EFS rates were respectively 61% and 57%.
Conclusion
The rarity of PGL has left many aspects of this neoplasm to remain unknown. In our study, the initial presentation was with nonspecific symptoms, which often leads to misdiagnose and delay of treatment similarly to data from literature. The most frequent site of lesions in our patients was the antrum of the stomach (29%) which is similar to literature data. The majority of the cases had localized disease (63%) which remains lower than the other reported series (75-84%). Complete remission rates (71%) and five years OS rates (61%) were lower than the values reported in other series in literature and which were respectively 80% and 70-75%. Early diagnosis, availability of Rituximab and autologous stem cell transplant in high risk forms may help to improve our results.
Keyword(s):
Abstract: PB1452
Type: Publication Only
Session title: Aggressive Non-Hodgkin lymphoma - Clinical
Background
Primary gastric lymphoma (PGL) is a rare disease. It is, however, the most common extra nodal non-Hodgkin lymphoma (NHL). Diffuse large B cell lymphoma (DLBCL) is the common aggressive subtype of gastric NHL.
Aims
The purpose of our study is to analyze its epidemiological aspects, clinical features, endoscopic aspects, therapeutic methods and prognostic factors in our center.
Methods
This retrospective study involved untreated patients with primary gastric large B cell lymphoma diagnosed between January 2006 and December 2019 in the hematology department of Sfax in Tunisia. The Musshoff-modified Ann Arbor System was used for clinical staging. We used the Revised International Prognostic index (R-IPI) score to evaluate prognosis.Patients were treated with chemotherapy (CHOP+/-R, ACVBP+/- R or mini CEOP/CHOP +/- R) alone or followed by radiation or autologous stem cell transplantation. The International Working Group Response Criteria for NHL 1999 was used to evaluate the response. To confirm complete remission, gastric lesions were evaluated by Endoscopy combined to Biopsy. Kaplan-Meier method was used to estimate overall survival (OS) and event free survival (EFS).
Results
A total of 24 eligible patients were identified. Sex ratio was 1.2.Median age was 59 years (17-82). The mean consultation delay was 9 months (1-48 months). Epigastric abdominal pain was the most common revealing symptom (83% of patients), it was associated to B symptoms in 75% of the cases. Performance Status of 2 or greater was noted in eight patients (33%). In Endoscopy, lesions were found more in gastric body and antrum (25%), there were 1 patient who had multiple located lesions and 1 who had diffuse gastric lesions. One patient had stenosis. Nasopharyngeal biopsy was performed on 10 patients and was positive in one case. Elevated LDH level were observed in 5 patients (21 %). 63% of the patients had localized disease (IE or IIE). Half of the patients were screened for Helicobacter Pylori Infection, it was present in 7 patients (58%). A quarter of gastric DLBCL were associated to low-grade mucosa associated lymphoid tissue (MALT) lymphoma. R-IPI was high in 12% of the cases, intermediate in 71% and low in 17%. The Median follow up was 120 months. One patient died of hemorrhagic shock before treatment and 4 patients died while undergoing chemotherapy. The treatment response was determined in 18 patients, among them:71% achieved complete remission, 24% were evaluated partial response and 5% were in progression. Five Years OS and EFS rates were respectively 61% and 57%.
Conclusion
The rarity of PGL has left many aspects of this neoplasm to remain unknown. In our study, the initial presentation was with nonspecific symptoms, which often leads to misdiagnose and delay of treatment similarly to data from literature. The most frequent site of lesions in our patients was the antrum of the stomach (29%) which is similar to literature data. The majority of the cases had localized disease (63%) which remains lower than the other reported series (75-84%). Complete remission rates (71%) and five years OS rates (61%) were lower than the values reported in other series in literature and which were respectively 80% and 70-75%. Early diagnosis, availability of Rituximab and autologous stem cell transplant in high risk forms may help to improve our results.
Keyword(s):