Abstract | AIM: MATERIAL AND METHODS: The study included 63 patients (40 females and 23 males aged 14 to 78 years, mean age 49 years) with primary diagnosis of gastric lymphosarcoma (GL). Of them, 56 (89%) patients had diffuse large B-cell lymphosarcoma (DLBCL) and 7 (11%) had gastric Berkitt's lymphoma (BL). Only detection of t(8;14) with rearrangement of c-myc gene provided accurate diagnosis of gastric BL. By the treatment DLBCL patients were divided into two groups: 44 patients of group 1 received polychemotherapy (PCT) according to CHOP scheme or in combination with radiotherapy and surgical treatment; 12 patients of group 2 were treated according to modified program mNHL-BFM-90, without surgical or radiation treatment. Of 7 patients with gastric BL 5 patients received treatment according to a modified program mNHL-BFM-90 and 2 patients were given CHOP because of DLBCL misdiagnosis without cytogenetic detection of t(8;14). RESULTS: Overall survival in group 1 was 73% in mean follow-up 61 months. The survival depended only on initial factors of poor prognosis (PPF): tumor size over 10 cm, Ann-Arbor stage higher than IE, B-symptoms, elevated level of LDH. Overall survival of 18 gastric DLBCL patients without PPF reached 94%, of 26 patients with PPF - 60%. Lethality due to side effects was 4% (2 patients), primary resistance was 14% (6 patients), recurrence arose in 9% (4 patients). Overall survival in group 2 was 100% in mean remission duration 18 months, was unrelated to PPF (10 of 12 patients) but correlated with high toxicity. 5 BL patients treated with a modified mNHL-BFM-90 program achieved remission (a mean follow-up at present is 1 to 50 months, mean 24 months). 2 BL patients treated with CHOP died for a year. CONCLUSION: Gastric lymphosarcomas are sensitive to chemotherapy, thereby PCT only is effective in most patients. PPF in gastric DLBCL were responsible for poor outcome in 40% patients in CHOP treatment. The modified program mNHL-BFM-90 can produce up to 100% complete long-term remissions in therapy of gastric lymphosarcoma in adults both in BL and DLBCL patients. A cytogenetic examination of c-myc gene rearrangement is obligatory before initiation of PCT of gastric lymphosarcoma.
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Authors | E E Zvonkov, A M Kremenetskaia, S K Kravchenko, V A Makhinia, I B Kaplanskaia, T N Obukhova, R S Samoĭlova, A A Shevelev, A U Magomedova, E A Bariakh, B B Krasil'nikova, A V Gubkin, E A Iliushkina, D S Mar'in, A K Morozova, S M Kulikov, E G Gemdzhian, A I Vorob'ev |
Journal | Terapevticheskii arkhiv
(Ter Arkh)
Vol. 80
Issue 7
Pg. 18-26
( 2008)
ISSN: 0040-3660 [Print] Russia (Federation) |
PMID | 18763589
(Publication Type: Clinical Trial, Comparative Study, English Abstract, Journal Article)
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Chemical References |
- Vincristine
- Doxorubicin
- Cyclophosphamide
- Asparaginase
- Prednisone
- Daunorubicin
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Topics |
- Adolescent
- Adult
- Aged
- Antineoplastic Combined Chemotherapy Protocols
(administration & dosage)
- Asparaginase
(administration & dosage)
- Burkitt Lymphoma
(drug therapy, mortality, pathology)
- Cyclophosphamide
(administration & dosage)
- Daunorubicin
(administration & dosage)
- Dose-Response Relationship, Drug
- Doxorubicin
(administration & dosage)
- Female
- Follow-Up Studies
- Humans
- Lymphoma, Large B-Cell, Diffuse
(drug therapy, mortality, pathology)
- Male
- Middle Aged
- Prednisone
(administration & dosage)
- Prospective Studies
- Retrospective Studies
- Stomach Neoplasms
(drug therapy, mortality, pathology)
- Survival Rate
- Time Factors
- Treatment Outcome
- Vincristine
(administration & dosage)
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