Treatment Outcome and Quality of Life in Non-Hodgkin's Lymphoma of Intestine: a Multicenter Study of the Consortium for Improving Survival of Lymphoma (CISL).

Intestine is the one of commonly involved extranodal sites of non-Hodgkin's lymphoma (NHL). Thus, small and large Intestine account for approximately 30-40% of primary gastrointestinal tract lymphoma. More than 70% of intestinal lymphoma presents as localized disease, and surgery such as bowel resection is performed in many patients with intestinal lymphoma for diagnosis and treatment. However, it is still unclear whether surgical resection followed by chemotherapy is superior to systemic chemotherapy alone in terms of treatment outcome and quality of life (QOL). Thus, we retrospectively analyzed the clinical features and treatment outcome of patients with NHL of intestine, and performed a multicenter cross-sectional study about the QOL in survivors of intestine NHL.

We evaluated 463 patients with intestine NHL from 15 hospitals affiliated with the Consortium for Improving Survival of Lymphoma (CISL) in Korea. The QOL was assessed in 84 survivors who completed their treatment using the EORTC QLQ-C30 questionnaire.

The median age was 55 years old (range 15-92), and male to female ratio was 1.79:1. 389 patients (84.0%) had the ECOG performance status less than 2. More than a half of patients (59.8%) presented as a localized disease: Ann Arbor stage IE (n = 127, 27.7%) and IIE (n = 150, 31.3%). The cases involving two or more than two extranodal sites were found in 26.6%, and the elevation of serum LDH was observed in 173 patients at diagnosis (37.4%). Thus, the majority of patients had low risk of IPI (50.8%, n=235) while high risk was 10.2% (n=47). The presence of B symptoms and invasion of bone marrow were relatively less frequent event (19.0% and 9.7%, respectively). The most common histological subtype was DLBCL (71.3%, n=330), and the frequency of other subtypes was as follows: MALT lymphoma (8.2%, 38), Burkitt lymphoma (6.7%, 31), PTCL (6.7%, 31), mantle cell lymphoma (3.7%, 17), and others. The frequency of involved sites was as follows: small intestine including terminal ileum and jejunum (61.7%), large intestine (26.6%), and small and large intestine (11.7%). The major treatment modality was surgery followed by chemotherapy or chemotherapy alone. Thus, 205 patients received surgery followed by chemotherapy while 170 patients received chemotherapy alone. The 5-year overall survival (OS) was 69.8% (95% CI: 64.18-72.82), and 5-year progression-free survival (PFS) was 67.2% (95% CI: 61.72-70.53). Because DLBCL accounts for more than 90% of patients treated with surgery plus chemotherapy or chemotherapy alone, the survival outcome was compared in stage IE/IIE of DLBCL as a subgroup analysis. 5-year OS was significantly higher in the group with surgery plus chemotherapy (86.67%, 95% CI: 81.43-91.9) than the group with chemotherapy alone (66.23%, 95% CI: 56.96-75.49, P < 0.001). However, there was no significant difference of OS in DLBCL patients with stage III/IV. When we compared the survival outcome according to the use of rituximab-CHOP versus CHOP, the addition of rituximab failed to show additional survival benefit in DLBCL patients with stage IE/IIE. The QOL of survivors was not significantly different based on the treatment modality except a tendency of better physical and role functioning in patients treated with chemotherapy alone. The global health status was comparable between two groups.

Surgery followed by chemotherapy might be a better treatment strategy for localized non-Hodgkin lymphoma of intestine in terms of survival and quality of life.

No relevant conflicts of interest to declare.