Main Article Content

Luca Guarnera
Federico Meconi
Roberto Secchi
Maria Rosaria Pascale
Fabiana Esposito
Annagiulia Zizzari
Vito Mario Rapisarda
Manuela Rizzo
Livio Pupo
Maria Cantonetti


Low-dose pre-phase chemotherapy, Diffuse Large B Cell Lymphoma with gastrointestinal involvement, Cyclophosphamide


Introduction Gastric Diffuse large B‐cell lymphoma (DLBCL) is the most common extra-nodal site of lymphoma’s involvement (30%-40% of all extranodal lymphomas and 55%-65% of all gastrointestinal lymphomas). However, gastric localizations are also sometimes found in systemic DLBCL. Gastric complications such as bleeding, perforation and stenosis under chemotherapy are well documented.  Methods We retrospectively analyzed 15 patients with newly diagnosed DLBCL with gastrointestinal involvement. Endoscopies were performed in these patients before and after treatment. Treatment consisted in cyclophosphamide low-dose pre-phase chemotherapy before conventional-dose chemotherapy. Results Endoscopy at staging detected ulcers in 12 patients (80%). After low-dose pre-phase chemotherapy GI ulcers healed in 91.6% of cases (1 ulcer detected). After the whole treatment (Low-dose pre-phase + chemotherapy) 9 patients (60%) achieved complete response, 4 patients (26.6%) partial response, 2 (13,3%) patients presented disease progression. The most frequent adverse event was neutropenia (73.3%); the most frequent non hematological adverse event was transaminases elevation (20%). Conclusion Cyclophosphamide low-dose pre-phase chemotherapy resulted a safe and effective way to prevent adverse events in systemic DLBCL with gastrointestinal involvement.


Download data is not yet available.

Abstract 646
PDF Downloads 355
HTML Downloads 160


[1] Morton, L. M. et al. Lymphoma incidence patterns by WHO subtype in the United States, 1992-2001. Blood (2006). doi:10.1182/blood-2005-06-2508
[2] Ghimire, P., Wu, G. Y. & Zhu, L. Primary gastrointestinal lymphoma. World J. Gastroenterol. (2011). doi:10.3748/wjg.v17.i6.697
[3] Al-Akwaa, A. M., Siddiqui, N. & Al-Mofleh, I. A. Primary gastric lymphoma. World Journal of Gastroenterology (2004). doi:10.3748/wjg.v10.i1.5
[4] Herrmann, R., Panahon, A. M., Barcos, M. P., Walsh, D. & Stutzman, L. Gastrointestinal involvement in non‐Hodgkin’s lymphoma. Cancer (1980). doi:10.1002/1097-0142(19800701)46:1<215::AID-CNCR2820460136>3.0.CO;2-6
[5] Coiffier, B. et al. Long-term outcome of patients in the LNH-98.5 trial, the first randomized study comparing rituximab-CHOP to standard CHOP chemotherapy in DLBCL patients: A study by the Groupe d’Etudes des Lymphomes de l’Adulte. Blood (2010). doi:10.1182/blood-2010-03-276246
[6] Sohn, B. S. et al. The comparison between CHOP and R-CHOP in primary gastric diffuse large B cell lymphoma. Ann. Hematol. (2012). doi:10.1007/s00277-012-1512-4
[7] Spectre, G. et al. Bleeding, obstruction, and perforation in a series of patients with aggressive gastric lymphoma treated with primary chemotherapy. Ann. Surg. Oncol. (2006). doi:10.1245/s10434-006-9069-x
[8] Cui, Y. et al. Safety and efficacy of low-dose pre-phase before conventional-dose chemotherapy for ulcerative gastric diffuse large B-cell lymphoma. Leuk. Lymphoma (2015). doi:10.3109/10428194.2015.1014366.
[9] Liu Y, Liu Y, Zhao P, et al. Switching Fractioned R-CHOP Cycles to Standard R-CHOP Cycles Guided by Endoscopic Ultrasonography in Treating Patients with Primary Gastric Diffuse Large B-Cell Lymphoma. Cancer Manag Res. 2020;12:5041-5048.
[10] Magnoli F, Bernasconi B, Vivian L et al. Primary extranodal diffuse large B-cell lymphomas: Many sites, many entities? Clinico-pathological, immunohistochemical and cytogenetic study of 106 cases. Cancer Genet. 2018 Dec;228-229:28-40.
[11] Ollila TA, Olszewski AJ. Extranodal Diffuse Large B Cell Lymphoma: Molecular Features, Prognosis, and Risk of Central Nervous System Recurrence. Curr Treat Options Oncol. 2018 Jun 21;19(8):38.
[12] International Non-Hodgkin's Lymphoma Prognostic Factors Project. A predictive model for aggressive non-Hodgkin's lymphoma. N Engl J Med. 1993 Sep 30;329(14):987-94. doi: 10.1056/NEJM199309303291402. PMID: 8141877.
[13] Bautista-Quach MA, Ake CD, Chen M, Wang J. Gastrointestinal lymphomas: Morphology, immunophenotype and molecular features. J Gastrointest Oncol. 2012;3(3):209-225. doi: 10.3978/j.issn.2078-6891.2012.024.
[14] List AF, Greer JP, Cousar JC et al. Non-Hodgkin's lymphoma of the gastrointestinal tract: an analysis of clinical and pathologic features affecting outcome. J Clin Oncol. 1988 Jul;6(7):1125-33. doi: 10.1200/JCO.1988.6.7.1125. PMID: 3392561.
[15] Spectre G, Libster D, Grisariu S, Da'as N, Yehuda DB, Gimmon Z, Paltiel O. Bleeding, obstruction, and perforation in a series of patients with aggressive gastric lymphoma treated with primary chemotherapy. Ann Surg Oncol. 2006 Nov;13(11):1372-8. doi: 10.1245/s10434-006-9069-x. Epub 2006 Sep 30. PMID: 17009162.
[16] Nowakowski GS, Czuczman MS. ABC, GCB, and Double-Hit Diffuse Large B-Cell Lymphoma: Does Subtype Make a Difference in Therapy Selection? Am Soc Clin Oncol Educ Book. 2015:e449-57. doi: 10.14694/EdBook_AM.2015.35.e449. PMID: 25993209.
[17] Nagakita K, Takata K, Taniguchi K et al. Clinicopathological features of 49 primary gastrointestinal diffuse large B-cell lymphoma cases; comparison with location, cell-of-origin, and frequency of MYD88 L265P. Pathol Int. 2016 Aug;66(8):444-52. doi: 10.1111/pin.12439. Epub 2016 Jul 20. PMID: 27439595.
[18] Sehn LH, Martelli M, Trněný M et al. U. A randomized, open-label, Phase III study of obinutuzumab or rituximab plus CHOP in patients with previously untreated diffuse large B-Cell lymphoma: final analysis of GOYA. J Hematol Oncol. 2020 Jun 6;13(1):71. doi: 10.1186/s13045-020-00900-7. PMID: 32505213; PMCID: PMC7276080.
[19] Cengiz M, Cetik Yildiz S, Demir C, Şahin İK, Teksoy Ö, Ayhanci A. Hepato-preventive and anti-apoptotic role of boric acid against liver injury induced by cyclophosphamide. J Trace Elem Med Biol. 2019 May;53:1-7. doi: 10.1016/j.jtemb.2019.01.013. Epub 2019 Jan 23. PMID: 30910191.