Gastrointestinal tract is the most frequent site of involvement in the primary extranodal lymphoma representing around40% of new diffuse large B-cell lymphoma (DLBCL) cases.The new enhanced(NCCN-IPI for patients uniformly treated with immunochemotherapy includes gastrointestinal tract as one of unfavourable extranodalsitesof involvement in DLBCL. We evaluated outcomes of patients with nodal compared to primary gastrointestinal DLBCL after R-CHOPtreatment.
Of 528 consecutive patients with DLBCL treated at our institution between 2004-2011 we identified 237 patients with de novo DLBCL, median age (range) 63(17-90),male/female 116/121, including 148patients with nodal and 89 with primary gastrointestinallymphoma (PGL). None of PGL patients had a radical surgery for the primary disease.
There wereno statistically significant differencies in median age, CS, rate of IPI ≥ 3 between nodal and PGL patients (pts). Characteristics frequency in patients with nodal disease and PGL were the following, respectively: performance status (PS) > 1:34% and 43%(p = 0.03), elevated LDH: 59% and 41% (p = 0.05), GCB-DLBCL subtype: 23% and 18%(p > 0.05). A minimum of 6 cycles of R-CHOP therapy was completed in 123 pts(83%) with nodal disease and 71 pts (72%) with PGL lymphoma, 5-year overall survival was 68% (95% CI; 60, 76) and 60% (95%CI; 49, 71), respectively (p = 0.22), and5-year progression free survivalwas 62% (95%CI; 54, 70) and60% (95%CI; 48, 72), respectively(p = 0.47). Relapse occurred in 32 (22%) pts with nodal disease and in 15 pts (18%) with PGL (p = 0.27) including relapse in central nervous system in 3 of 32 (9%) relapsed ptswith nodal disease and in 4 of 15(26%) relapsed ptswith GI lymphoma (p = 0.12). In a long term follow up, second primary malignancy was recordedin 10 (7%) of pts with nodal disease and in 3 (4%) of pts with PGI lymphoma (p = 0.53).
Our data is not in support of unfavorable role of GI site of primary involvement compared to nodal DLBCL. Central nervous system relapse was more frequent in PGL than in nodal lymphoma but the difference was not statistically significant.
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All authors have declared no conflicts of interest.