Treatment And Prognosis For Diffuse Large B-cell Lymphoma And NK/T-cell Lymphoma

Objective:Gastrointestinal tract is one of the most common extranodal primary sites of diffuse large B-cell lymphoma(DLBCL).Primary gastrointestinal DLBCL is a heterogeneous disease.This study aimed to compare the clinical difference between primary gastric DLBCL(PG-DLBCL)and primary intestinal DLBCL(PI-DLBCL).Methods:Between December 2002 and January 2013,a total of 60 patients with PG-DLBCL and 41 patients with PI-DLBCL were retrospectively analyzed at the Cancer Hospital of Chinese Academy of Medical Sciences in this study.Comparison of clinical features was performed using the chi-square tests for categorical variables.The survival rates were calculated using the Kaplan-Meier method.Results:The median age was 55 years old in PG-DLBCL group and 48 years old in PI-DLBCL group.The ratio of males to females was 1.14:1 and 3.1:1,respectively.We found bulky disease and elevated lactate dehydrogenase(LDH)were more common in PI-DLBCL compared with PG-DLBCL.The percentage of patients with International Prognostic Index(IPI)score 0,1 and ?2 was 40.0%,30.0%and 30.0%in PG-DLBCL group.In PI-DLBCL group,the percentage of patients with IPI score 0,1 and ?2 was 24.4%?29.3%and 46.3%,respectively.With a median follow-up of 56 months(range,1-156 months),the 5-year overall survival(OS)rates for patients with PG-DLBCL and PI-DLBCL were 77.1%and 66.1%(p=0.201),and the 5-year progression-free survival(PFS)rates were 65.7%and 53.2%(p=0.248),respectively.For all PG-DLBCL patients,first-line rituximab plus chemotherapy could significantly improve the 5-year OS rates(92.7%versus 62.2%,p=0.011)and PFS rates(83.2%versus 48.4%,p=0.002)compared with conventional chemotherapy.First-line rituximab plus chemotherapy resulted in higher 5-year OS rates(79.2%versus 45.8%,p = 0.047)and PFS rates(61.1%versus 39.0%,p=0.211)compared with conventional chemotherapy in all PI-DLBCL patients.,but the difference was not significant for PFS.Surgical resection did not offer survival benefits for patients with stage ?/? PG-DLBCL.In contrast,patients with stage ?/? PI-DLBCL receiving surgery achieved higher 5-year OS rates(90.5%versus 61.0%,p=0.054)and PFS rates(79.1%versus 47.6%,p=0.041)compared with those without surgery.Conclusion:Some clinical disparities exist between PG-DLBCL and PI-DLBCL.First-line rituximab plus chemotherapy could improve the 5-year OS rates and PFS rates compared with conventional chemotherapy for PG-DLBCL and PI-DLBCL patients.Surgical resection could offer survival benefits for patients with stage ?/? PI-DLBCL,but it is not recommended for stage I/II PG-DLBCL.Objective:Diffuse large B-cell lymphoma(DLBCL)and extranodal NK/T-cell lymphoma(ENKTL)are most common subtypes of sinonasal lymphomas and mainly diagnosed at the localized stage,but the difference on clinical features and treatment outcomes between them is not clear.This study aimed to compare the clinical characteristics,treatment protocols and prognoses of localized sinonasal DLBCL(SN-DLBCL)and sinonasal ENKTL(SN-ENKTL).Methods:Between 2000 and 2014,a total of 47 patients with localized sinonasal DLBCL(SN-DLBCL)and 211 patients with localized sinonasal ENKTL(SN-ENKTL)were compared at the Cancer Hospital of Chinese Academy of Medical Sciences in this retrospective analysis.Comparison of clinical features was performed using the chi-square tests for categorical variables.The survival rates were calculated using the Kaplan-Meier method.Results:SN-ENKTL occurred predominately in young persons who were mostly males with more common B symptoms.Patients with SN-DLBCL who seldomly presented with limited stag I disease and B symptoms had a higher median age(63 years old)than those with SN-ENKTL(40 years old).The ratio of males to females was 1.14:1 in SN-DLBCL and 2.40:1 in SN-ENKTL.However,both SN-DLBCL and SN-ENKTL patients could achieve high objective response rates(ORR,89.3%vs 88.2%)and favorable prognoses.With a median follow-up of 46.5 months,(range,1-158 months),the 3-year overall survival(OS)rates for patients with SN-DLBCL and SN-ENKTL were 79.7%and 83.6%(p = 0.707),and the 3-year progression-free survival(PFS)rates were 61.4%and 70.1%(p = 0.294),respectively.For SN-DLBCL patients,chemotherapy followed by involved-field radiotherapy(IFRT)resulted in higher 3-year OS(83.7%vs 62.5%)and PFS(63.9%vs 50.0%)rates compared with chemotherapy alone,but the difference was not significant.No significant difference was found in the 3-year OS(84.5%vs 85.2%,p = 0.783)or PFS(68.4%vs 75.6%,p = 0.183)rates between radiotherapy alone and radiotherapy combined with chemotherapy for all patients with SN-ENKTL.But in extensive stage I and stage II SN-ENKTL patients,radiotherapy combined with chemotherapy could significantly improve the 3-year PFS(73.8%vs 50.0%)compared with radiotherapy alone.And the 3-year OS(83.6%vs 71.7%,p = 0.110)rate was also higher in the radiotherapy combined with chemotherapy group.Conclusion:These results indicate that remarkable clinical disparities exist between localized SN-DLBCL and SN-ENKTL.However,different treatment strategies for them could result in similarly favorable prognoses.For SN-DLBCL patients,chemotherapy followed by IFRT results higher 3-year OS and PFS rates compared with chemotherapy alone,but the difference was not significant.For extensive stage ? and stage ?SN-ENKTL patients,radiotherapy combined with chemotherapy could significantly improve the 3-year PFS compared with radiotherapy alone.Objective:Extranodal natural killer(NK)/T-cell lymphoma,nasal type(ENKTL)is an aggressive non-Hodgkin lymphoma in China.The incidence of ENKTL is much higher in China than in Western countries.Chemotherapy in combination with radiotherapy have been used for localized ENKTL,but the best first-line chemotherapy regimen has not been defined.This retrospective analysis aimed to assess the efficacy and safety of GDP(gemcitabine,dexamethasone,and cisplatin)chemotherapy in patients with stage ?/?ENKTL after radiation therapy.Methods:In this retrospective analysis,forty-four patients with stages ?/? ENKTL were enrolled and received GDP chemotherapy after radiation therapy from March 2009 to December 2015 at the Cancer Hospital of Chinese Academy of Medical Sciences.The median number of chemotherapy cycles per patient was 4(range,2-6 cycles).Results:The median age of 44 patients was 40.5 years old(range,20-65 years)and the male to female ratio was 32:12.Only 4(9%)patients were in limited stage I,23(52%)patients were in extensive stage I and 17(39%)patients were in stage ?.B symptoms were observed in 27 patients(63%)and lactate dehydrogenase(LDH)was elevated in 14 patients(32%).17(37%)patients were with nodal involvement.After radiation therapy,31 patients achieved complete response(CR)and received consolidation chemotherapy.Among 11 patients who achieved partial response(PR)after radiation therapy,8 of them achieved CR after chemotherapy,and the other 3 patients was in stable disease(SD)after chemotherapy.2 patients developed systemic progression after radiation therapy and were insensitive to chemotherapy.With a median follow-up of 37.5 months(range,6-90 months),the 3-year overall survival(OS)rate and progression-free survival(PFS)rate were 85%(95%CI,74%to 96%)and 77%(95%CI,64%to 91%),respectively.The major adverse events of GDP chemotherapy were leukopenia,neutropenia,anemia,thrombocytopenia,nausea and vomiting.The most common grade 3 to 4 adverse events included leukopenia(37%)and neutropenia(34%).No treatment-related deaths were observed.Conclusion:This retrospective analysis suggested good efficacy and low toxicity of GDP regimen chemotherapy for stage ?/? ENKTL patients after radiation therapy.These results require further investigation in prospective trials.