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

Yizhen Liu,1 Yumei Liu,2 Ping Zhao,3 Qunling Zhang,1 Xiaojian Liu,1 Fangfang Lv,1 Xiaonan Hong,1 Junning Cao,1 Kai Xue1,4 1Department of Medical Oncology, Fudan University Shanghai Cancer Center; Department of Oncology, Shanghai Medical College, Fudan University, Shanghai 200032, People’s Republic of China; 2Department of Endoscopy, Fudan University Shanghai Cancer Center; Shanghai Medical College, Fudan University, Shanghai 200032, People’s Republic of China; 3Department of Biology, University of North Alabama, Florence, AL 35632, USA; 4State Key Laboratory of Medical Genomics, National Research Center for Translational Medicine at Shanghai, Ruijin Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 200025, People’s Republic of ChinaCorrespondence: Kai XueDepartment of Medical Oncology, Fudan University Shanghai Cancer Center, 270 Dongan Road, Shanghai 200032, People’s Republic of ChinaTel +86 21 64175590Email xuekaishanghai@126.comBackground: Primary gastric diffuse large B-cell lymphoma (PG-DLBCL) is a common subtype of extranodal non-Hodgkin lymphoma (NHL), with rituximab, cyclophosphamide, doxorubicin, vincristine and prednisone (R-CHOP) as the commonly used treatment regimen. However, full cycles of standard R-CHOP present the risk of severe bleeding or perforation, even leading to emergency surgery, especially for those with deep lesions in their first 1– 2 cycles of treatment. This study aims to explore the safety and efficacy of fractioned R-CHOP (rituximab d0, 50% dose of CHOP d1 and d5) followed by standard R-CHOP cycles in PG-DLBCL patients guided by endoscopic ultrasonography (EUS).Patients and Methods: Thirty-one PG-DLBCL patients were analyzed in this retrospective study. All patients had lesions infiltrated to at least the 3rd layer of the stomach under EUS at baseline. Patients switched to standard R-CHOP if they showed the reduced infiltrated layers and restricted lesions after fractioned R-CHOP cycles.Results: The overall response rate, 5-year progression-free survival (PFS) and overall survival (OS) of patients in our study were 93.5%, 75% and 84%, respectively. No treatment delay or dosage reduction from gastric adverse event was observed. None of the patients in our study suffered from severe bleeding or perforation during the treatment. Kaplan–Meier analyses showed that PG-DLBCL patients characterized by multiple localization, lesions ≥ 3cm, having B symptoms, lower serum albumin level, and elevated LDH level were associated with worse PFS and OS.Conclusion: Our data indicate that it might be an effective approach in treating deeply infiltrated PG-DLBCL patients by switching fractioned R-CHOP to standard R-CHOP cycles guided by EUS.Keywords: primary gastric diffuse large B-cell lymphoma, endoscopic ultrasonography, R-CHOP, prognosis