rev bras hematol hemoter. 2016;38(3):186–187
w w w . r b h h . o r g
Revista
Brasileira
de
Hematologia
e
Hemoterapia
Brazilian
Journal
of
Hematology
and
Hemotherapy
Scientific
Comment
Diffuse
large
B
cell
gastric
lymphoma
a
rare
disease:
the
effort
to
obtain
scientific
data
in
a
multicenter,
multinational
retrospective
trial
夽
Nelson
Hamerschlak
∗HospitalIsraelitaAlbertEinstein,SãoPaulo,SP,Brazil
Primary diffuse large B cell gastric lymphoma (DLBCGL) accountsforapproximately1.5%ofgastricneoplasmsand5% oflymphomas.1Itrepresents30–40%ofthegastrointestinal lymphomasand it is the mostcommon extranodal site of lymphoma.Generally,it occursinpatients between50and 60yearsoldandthereisaslightmalepredominance.2
Themostcommonsymptomisepigastricpainbutpatients canpresentwithanorexia,nauseaorvomiting,weightloss andbleeding.Endoscopyandbiopsyshouldbeperformedin thiskindofpatientforthecorrectdiagnosis.Sometimespinch biopsiesmaymissthediagnosisandlargersampleshaveto beattained.3–5 The use ofendoscopic ultrasoundand flow cytometrymayachievehigheraccuracyrates.2–5
An association of Helicobacter pylori with DLBCGLexists and treatment to eradicate H. pylori has to be used in themanagementofthedisease whennecessary.6 Veryfew patientsoutsideclinicaltrialsarecandidatesforonlyH.pylori therapy.
TheAnnArborstagingsystemisnotalwaysconsidered asatoolingastrointestinallymphomasbutthereislimited consensusintheuseofseveralotherstagingsystems.7
TreatmentoptionsforDLBCGLincludesurgery,radiation therapy and chemoimmunotherapy with or without treat-ment for H. pylori or a combination of the above. Surgery
DOIoforiginalarticle:http://dx.doi.org/10.1016/j.bjhh.2016.04.010.
夽
SeepaperbyDelamainetal.onpages247–51.
∗ Correspondingauthorat:CentrodePesquisaClínica,InstitutoIsraelitadeEnsinoePesquisaAlbertEinstein,Av.AlbertEinstein,627/520,
05651-901SãoPaulo,SP,Brazil. E-mailaddress:hamer@einstein.br
isusedinpatients withcomplicationssuchasperforation, severebleedingorobstruction.Nowadays,themajorityofthe patientsaretreatedwithrituximab-basedchemotherapywith orwithoutradiotherapyconsolidation.8,9
ThepaperbyDelamainetal., publishedinthisissueof theRevistaBrasileiradeHematologiaeHemoterapia(RBHH), addressesthemainfindingsofDLBCGLinamulticenter retro-spectivestudywith104patientsfromthreecountries,Brazil, PortugalandItaly.Thiskindofstudyisveryimportantinrare diseasessincethemajorityoftherecommendationsarebased ondatafromcaseseries,ratherthanlargerandomizedtrials.10 Different to the literature,the authors found a slightly higher incidencein women, advanced stageand high-risk age-adjusted internationalprognostic index (aaIPI)at diag-nosis. Themedianage was inagreement withthe current literatureand13%ofthepatientswerepositiveforH.pylori. Fewpatientsrequiredsurgerybecauseofcomplications.The patients were treated with rituximab with the cyclophos-phamide,doxorubicinhydrochloride,vincristinesulfateand prednisoneregimen(R-CHOP)withor withoutradiotherapy andtheauthorsgotimpressiveresultsconsideringnotonly completeremission,butalsooverallsurvivalrates.Theyalso contributetotheliteraturebyidentifyingtheaaIPIasa pre-dictorfactorforthesurvivalofpatients.
http://dx.doi.org/10.1016/j.bjhh.2016.05.014
rev bras hematol hemoter. 2 0 1 6;38(3):186–187
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Conflicts
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Theauthordeclaresnoconflictsofinterest.
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