Complications and outcomes in diffuse large B-cell lymphoma with gastric lesions treated with R-CHOP

Standard therapy for gastric diffuse large B-cell lymphoma (DLBCL) is considered to be chemotherapy with or without involved-field radiation therapy. Although R-CHOP therapy alone is widely used for DLBCL with gastric lesions (DLBCL-GL), the outcome and incidence of treatment-related gastric complications following R-CHOP are not well known. This study aimed to evaluate the outcome after R-CHOP therapy in patients with gastric DLBCL including gastric complications and to identify risk factors for the complications. Consecutive patients with newly diagnosed DLBCL-GL treated with R-CHOP between 2003 and 2014 were retrospectively evaluated. DLBCL-GL was defined only when pathologically confirmed in the stomach. Of the 96 patients with DLBCL-GL, 63 patients were diagnosed with gastric symptoms. Eighty-eight patients (92%) completed six to eight cycles of R-CHOP. The complete remission (CR) rate was 86%, and 3-year and 5-year overall survival rates were 80% and 73%, respectively. Patients were well stratified according to the Revised International Prognostic Index (R-IPI). Complication rate was 8% (8/96); seven patients had bleeding and three had stenosis. No patients had gastric perforation. Bleeding occurred during the first cycle of R-CHOP in five patients (5/7, 71%). Patients with gastric complications had a lower R-CHOP completion rate (50%, P = 0.001) and a lower CR rate (25%, P < 0.001) than those without complications. A low serum albumin level at diagnosis was the only risk factor identified for gastric complications (P = 0.001) and six of the eight patients with complications were shown to be at stage IV. Further studies of DLBCL-GL are warranted to identify patients at high risk for gastric complications and to provide better treatment strategies.