Management of Primary Gastrointestinal Non-Hodgkin Lymphoma with Lenalidomide

Primary gastrointestinal non-Hodgkin lymphoma is a heterogeneous malignancy with limited data to guide management. We analyzed the clinical characteristics and treatment outcomes of patients with primary gastrointestinal non-Hodgkin lymphoma treated with or without lenalidomide in a single-center patient cohort. The Kaplan-Meier method was used for survival analysis. The log-rank test was used to perform univariate survival analysis, and Cox multivariable analysis was carried out to analyze significant (P < 0.05) factors from the univariate analysis. The cohort included 219 patients, of whom 140 (64%) had primary gastric lymphoma and 79 (36%) had primary intestinal lymphoma. Most tumors (205; 93%) were composed of predominantly B-cell lymphoma; diffuse large B-cell lymphoma was the most common pathologic type for both primary gastric lymphoma and primary intestinal lymphoma. Univariate analysis showed that lesion location, age, clinical stage, and sex were not associated with overall survival, but MYC rearrangement, tumor cell type, international prognostic index score, and malignant degree were associated with prognosis. Multivariable analysis showed that MYC rearrangement and tumor cell type were independent prognostic factors. The OS and PFS of patients with MYC rearrangement were shorter than that of patients without MYC rearrangement indicating that MYC rearrangement was associated with decreased survival. Neither overall survival nor progression-free survival differed between patients who received chemotherapy with surgery and those who received chemotherapy without surgery, but patients who received surgery alone had a poor prognosis. Surgery was mainly conducted to relieve tumor-related complications or to make the diagnosis. For patients with invasive B-cell lymphoma with MYC rearrangement, the addition of lenalidomide (25 mg daily, days 1-21) to chemotherapy were given. Both of the OS and PFS of patients with lenalidomide were prolonged compared with patients without lenalidomide indicating that lenalidomide could improve the prognosis of patients with invasive B-cell lymphoma with MYC rearrangement.

Keywords: primary gastrointestinal lymphomas, lenalidomide, prognosis