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Influence of Severe Gastrointestinal Complications in Primary Gastrointestinal Diffuse Large B-Cell Lymphoma
Ye Shen1, Jinping Ou1, Bingjie Wang1
1Department of Hematology, Peking University First Hospital, Beijing, 100034, People's Republic of China.
Insights
Gastrointestinal complications like bleeding, obstruction, and perforation significantly worsen survival in patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL). These complications, especially after chemotherapy, reduce treatment response and long-term outcomes.
Area of Science:
- Oncology
- Gastroenterology
- Hematology
Background:
- Primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) is a rare non-Hodgkin lymphoma.
- Gastrointestinal complications (GICs) such as bleeding (GIB), obstruction (GIO), and perforation (GIP) can occur in PGI-DLBCL patients.
- The impact of these GICs on patient outcomes and survival is not fully understood.
Purpose of the Study:
- To assess the clinical characteristics of GIB, GIO, and GIP in PGI-DLBCL patients.
- To evaluate the influence of GICs on the long-term survival of PGI-DLBCL patients.
- To identify risk factors for GICs and their impact on treatment response.
Main Methods:
- Retrospective analysis of 148 PGI-DLBCL patients from August 1994 to May 2018.
- Recorded clinical characteristics of GIB, GIO, and GIP before and after chemotherapy.
- Analyzed overall survival and progression-free survival in relation to GICs.
Main Results:
- 56.8% of patients experienced GICs, with 22.6% occurring post-chemotherapy.
- Severe GICs were associated with ECOG score ≥2, tumor mass ≥10 cm, or intestinal involvement.
- GICs before or after chemotherapy reduced objective response rates and significantly worsened prognosis, particularly GIP and GIB post-chemotherapy.
Conclusions:
- Gastrointestinal complications adversely affect quality of life and prolong hospitalization.
- GICs significantly shorten long-term survival in PGI-DLBCL patients.
- Early identification and management of GICs are crucial for improving patient outcomes.
Background:
This study assessed the clinical characteristics of gastrointestinal bleeding (GIB), obstruction (GIO), and perforation (GIP) in patients with primary gastrointestinal diffuse large B-cell lymphoma (PGI-DLBCL) and the influence on long-term survival.
Methods:
A retrospective analysis was performed of 148 patients with PGI-DLBCL admitted to Peking University First Hospital from August 1994 to May 2018. The clinical characteristics of GIB, GIO, and GIP before and after chemotherapy were recorded. The associated overall survival and progression-free survival were analyzed.
Results:
Among 148 patients, 56.8% had gastrointestinal complications (GICs), including GIB, GIO, GIP, and multiple complications, and 22.6% of them occurred after chemotherapy, mostly during the first 4 cycles. The most common clinical manifestations of patients with GICs were abdominal pain or discomfort (79.8%), hematemesis or melena (22.6%), and abnormal bowel habits (17.9%). Patients with Eastern Cooperative Oncology Group (ECOG) score ≥2, tumor mass ≥10 cm, or intestinal involvement had significantly higher risk of severe GICs as initial manifestations. Among 130 patients who received chemotherapy, B symptoms, tumor mass ≥10 cm, and Lugano stage (IIE, IV) strongly correlated with GICs after chemotherapy (P < 0.05). Rituximab did not increase the risk of GICs. GICs which occurred before or after chemotherapy reduced the objective response rate at the end of chemotherapy. The prognosis of patients was significantly worsened by GIP, GIB, or multiple complications after chemotherapy (P < 0.05). GIB at presentation or GIO before or after chemotherapy had no prognostic value (both P > 0.05).
Conclusion:
GICs adversely affect the quality of life, prolong the length of hospitalization, and shorten the long-term survival of patients with PGI-DLBCL.
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