P-076 - Survival outcome of patient with primary gastric diffuse large B-cell lymphoma: An Institutional experience from developing country

Date 04 July 2015
Event WorldGI 2015
Session Posters
Topics Lymphomas
Presenter A. Gogia
Citation Annals of Oncology (2015) 26 (suppl_4): 1-100. 10.1093/annonc/mdv233
Authors A. Gogia1, V. Raina2
  • 1All India Institute Of Medical Sciences, New Delhi/IN
  • 2AIIMS, New Delhi/IN

Abstract

Introduction

Primary gastric diffuse large B cell lymphoma (PGDLBCL) accounts for 1% of gastric malignancies and 20% of all gastrointestinal lymphoma. PGDLBCL occurs as de-novo or can arise rarely from transformation of MALT lymphoma to diffuse large B cell lymphoma. There is lack of data regarding PGDLBCL from developing countries.

Methods

In this retrospective study, 47 patients with PGDLBCL from 2009 to 2013 were included at All India Institute of Medical Sciences, New Delhi, India. Their clinical features, base line IPI score, stage at presentation, bone marrow (BM) involvement and type of treatment were recorded.

Results

Median age was 42 years (range 20-76yrs), with thirty-one males (66%) and sixteen females (34%). Median duration of symptoms was 4.5 months, B-symptoms were present in 28 (60%) patients and 30 (63%) patients were presented with poor performance status (ECOG 3/4). BM involvement was seen in three patients (6%). According to Ann Arbor staging, 30 patients (64%) were in stage I, 07 (15%) stage II, 02 (4%) stage III and 08 (17%) in stage IV. IPI risk categorizations, low risk 30%, low intermediate risk 20%, high intermediate risk 20% and high risk 30%. Thirty-two patients (68%) were treated with CHOP chemotherapy and R- CHOP was given to 13 patients (28%)and rest were treated with CVP regimen. Radiation therapy was received as consolidative treatment in 60% of cases. Helicobacter pylori treatment was given to 10 (20%) patients after antibody test positivity. Median follow up was 3.9 years (range 1-6 years). Median event free (EFS) and overall survival (OS) was 65% and 55%. EFS in patients treated with chemotherapy + XRT with or without rituximab was 70% and 35% in patients treated with chemotherapy with or without rituximab (p = 0.001).

Conclusion

PGDLBCL consists 5% of all gastric malignancies at our centre. Most of the patients presented with B symptoms and have poor performance status at presentation. H. Pylori positivity is seen in 20% of cases. Consolidative radiation therapy and addition of rituximab to CHOP has a statistical significant survival impact in patients with PGDLBCL. RT may be omitted in selective cases of PGDLBCL, where RCHOP (rituximab based chemotherapy) is being considered, to avoid radiation induced side effect with same survival.