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Primary Diffuse Large B-cell Lymphoma of the Stomach: Prognostic factors and Outcomes in 160 Indian patients
Proceedings of the 52nd Annual ASTRO Meeting moderate, with 7.7% (5/65) of patients experiencing profound (Platelets \ 10,000) thrombocytopenia, which was prolonged, lasting more than 20 weeks. There were no bleeding complications, and no patient required a transfusion. For the remaining 60 patients, platelet counts decreased mildly for 4-6 weeks following RIT, and then returned to normal values by 10-20 weeks. Conclusions: RIT has yielded promising 5 year results in NHL patients’ refractory to Chemotherapy and Rituxan. Toxicity has been acceptable. RIT may be considered for first line treatment in some cases of NHL. Author Disclosure: R.S. Akins, None; R.J. Mark, None; P.J. Anderson, None; M. Nair, None; D. Quick, None.
2781
Primary Diffuse Large B-cell Lymphoma of the Stomach: Prognostic factors and Outcomes in 160 Indian patients
A. Bandyopadhyay, S. Laskar, R. Nair, S. Gujral, T. Shet, M. Sengar, H. Menon, M. A. Muckaden, G. Bahl Tata Memorial Hospital, Mumbai, India, Mumbai, India Purpose/Objective(s): To evaluate the prognostic factors and treatment outcome of Indian patients with primary Diffuse Large BCell Lymphoma (DLBCL) of the stomach treated at a single institution. Materials/Methods: From January 1990 to December 2007, 160 patients with DLBCL of the Stomach were treated at the Tata Memorial Hospital, Mumbai. Median age was 49 years, and the majority of patients (69%) were males. Systemic symptoms were present in 21% of patients; 23% had a WHO performance status (PS) of 2 or more; 36% presented with stage I, 43% had stage II, and 21% had Stage III-IV disease. On initial endoscopy, 46% (n = 74) had single lesions, while the remaining had multiple lesions or diffuse involvement of the stomach. As per the international prognostic index (IPI), 59.5% (n = 95) were low risk, 23% (n = 37) were low intermediate, 13% (n = 21) were intermediate, and 4.5% (n = 4) were high risk. Treatment comprised of chemotherapy (CTh) alone for 39% (n = 62), Surgery (Sx) and CTh for 22.5% (n = 36), CTh and radiotherapy (RT) for 33% (n = 53), and all three modalities were used in 5.5% (n = 9). Amongst those receiving RT, 37% were treated using 3D-CRT technique and 64.5% received an RT dose of .40Gy. Results: After a median follow-up of 52 months, the 5-year PFS and OS were 59.3% and 68.1%, respectively. On multivariate analysis; age $ 50yrs (HR = 2.17, 95% CI = 1.17-3.99, p = 0.013), WHO PS $2 (HR = 1.91, 95% CI = 1.02-3.58, p = 0.045), presence of multiple or diffuse lesions on endoscopy (HR = 2.17, 95% CI = 1.13-4.18, p = 0.020), and Hb level \10gm/dl (HR = 1.90, 95% CI = 1.04-3.48, p = 0.038) were found to have a significant negative influence on the OS. The IPI was also found to be a significant prognostic indicator for 5yr-OS: low = 78.5% vs. low-intermediate = 61.4% vs. intermediate = 42.4% vs. high = 28.6%, p \ 0.001. Combined modality treatment resulted in a significantly better outcome than CTh alone (5yr-OS: CT+RT = 79.3% vs. Sx+CT = 73.2% vs. Sx+CT+RT = 76.2% vs. CT Alone = 55.5%, p = 0.005). On multivariate analysis, the hazard ratio for death in patients receiving CT alone was 2.31 (95% CI = 1.22-4.37, p = 0.010). The PFS (p \ 0.001) and OS (p = 0.001) rates were significantly better for patients receiving a RT dose of .40Gy. Conclusions: Age at diagnosis, WHO PS, Hb level, IPI, and the number of lesions in the stomach significantly influence outcome in patients with primary gastric DLBCL. Combined modality treatment, comprising of CTh and RT (with a RT dose of .45Gy), results in satisfactory outcome in patients with this uncommon neoplasm. Author Disclosure: A. Bandyopadhyay, None; S. Laskar, None; R. Nair, None; S. Gujral, None; T. Shet, None; M. Sengar, None; H. Menon, None; M.A. Muckaden, None; G. Bahl, None.
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A Prospective Study of FDG-PET Imaging in Assessment of Response to Therapy in Patients with Relapsed or Refractory Non-Hodgkin’s Lymphoma Undergoing Salvage Chemotherapy and Autologous Stem Cell Transplant
C. L. Hann J. Sussman McMaster University, Hamilton, ON, Canada Purpose/Objective(s): Autologous stem cell transplant (ASCT) can salvage patients with refractory or relapsed non-Hodgkin’s lymphoma (NHL). Response to salvage chemotherapy is critical to selecting patients who might benefit from ASCT. Traditional response assessment using anatomic imaging results in modest success rates. It has been proposed that assessment with functional imaging using FDG-PET may improve the selection of patients who are likely to benefit from ASCT. Materials/Methods: Prospective longitudinal cohort study of patients with relapsed or refractory aggressive histology NHL planned for salvage HDT and ASCT between June 2005 and June 2009. Patients had baseline (T1) assessment and reassessment (T2) after 2 cycles of HDT with CT and FDG PET. PET scanning was reported as positive or negative using standard criteria. Consolidative radiation was not mandated. Primary outcome is 1 year Disease Free Survival (DFS) in relationship to FDG PET. Secondary outcomes include: time to first relapse (TTFR) and site of first relapse in relationship to second PET scan. Results: Twenty-four patients entered the trial, 18 underwent transplant. Of 6 patients who did not proceed to ASCT, 5 had disease progression and, 1 had PET- T1 scan. Median follow-up after ASCT was 24 months (range: 7-60). Salvage conditioning was either DHAP (n = 8) or GDP (n = 10). Of the 18 patients transplanted 12 had negative T2 PET scans and 6 had positive T2 PET scans. At 12 months, 0/12 PET- patients relapsed, while 3/6 PET + patients failed (p = 0.0245 Fisher’s exact test). Median TTFR was 4.3 months. All relapses occurred in sites of disease identified on T2 scans. Conclusions: Our results support use of FDG PET in addition to CT in assessing patients prior to ASCT with relapsed or refractory aggressive histology NHL. Patients who have a positive PET scan after salvage chemotherapy are at a significant risk of failure
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2781
Primary Diffuse Large B-cell Lymphoma of the Stomach: Prognostic factors and Outcomes in 160 Indian patients
A. Bandyopadhyay, S. Laskar, R. Nair, S. Gujral, T. Shet, M. Sengar, H. Menon, M. A. Muckaden, G. Bahl Tata Memorial Hospital, Mumbai, India, Mumbai, India Purpose/Objective(s): To evaluate the prognostic factors and treatment outcome of Indian patients with primary Diffuse Large BCell Lymphoma (DLBCL) of the stomach treated at a single institution. Materials/Methods: From January 1990 to December 2007, 160 patients with DLBCL of the Stomach were treated at the Tata Memorial Hospital, Mumbai. Median age was 49 years, and the majority of patients (69%) were males. Systemic symptoms were present in 21% of patients; 23% had a WHO performance status (PS) of 2 or more; 36% presented with stage I, 43% had stage II, and 21% had Stage III-IV disease. On initial endoscopy, 46% (n = 74) had single lesions, while the remaining had multiple lesions or diffuse involvement of the stomach. As per the international prognostic index (IPI), 59.5% (n = 95) were low risk, 23% (n = 37) were low intermediate, 13% (n = 21) were intermediate, and 4.5% (n = 4) were high risk. Treatment comprised of chemotherapy (CTh) alone for 39% (n = 62), Surgery (Sx) and CTh for 22.5% (n = 36), CTh and radiotherapy (RT) for 33% (n = 53), and all three modalities were used in 5.5% (n = 9). Amongst those receiving RT, 37% were treated using 3D-CRT technique and 64.5% received an RT dose of .40Gy. Results: After a median follow-up of 52 months, the 5-year PFS and OS were 59.3% and 68.1%, respectively. On multivariate analysis; age $ 50yrs (HR = 2.17, 95% CI = 1.17-3.99, p = 0.013), WHO PS $2 (HR = 1.91, 95% CI = 1.02-3.58, p = 0.045), presence of multiple or diffuse lesions on endoscopy (HR = 2.17, 95% CI = 1.13-4.18, p = 0.020), and Hb level \10gm/dl (HR = 1.90, 95% CI = 1.04-3.48, p = 0.038) were found to have a significant negative influence on the OS. The IPI was also found to be a significant prognostic indicator for 5yr-OS: low = 78.5% vs. low-intermediate = 61.4% vs. intermediate = 42.4% vs. high = 28.6%, p \ 0.001. Combined modality treatment resulted in a significantly better outcome than CTh alone (5yr-OS: CT+RT = 79.3% vs. Sx+CT = 73.2% vs. Sx+CT+RT = 76.2% vs. CT Alone = 55.5%, p = 0.005). On multivariate analysis, the hazard ratio for death in patients receiving CT alone was 2.31 (95% CI = 1.22-4.37, p = 0.010). The PFS (p \ 0.001) and OS (p = 0.001) rates were significantly better for patients receiving a RT dose of .40Gy. Conclusions: Age at diagnosis, WHO PS, Hb level, IPI, and the number of lesions in the stomach significantly influence outcome in patients with primary gastric DLBCL. Combined modality treatment, comprising of CTh and RT (with a RT dose of .45Gy), results in satisfactory outcome in patients with this uncommon neoplasm. Author Disclosure: A. Bandyopadhyay, None; S. Laskar, None; R. Nair, None; S. Gujral, None; T. Shet, None; M. Sengar, None; H. Menon, None; M.A. Muckaden, None; G. Bahl, None.
2782
A Prospective Study of FDG-PET Imaging in Assessment of Response to Therapy in Patients with Relapsed or Refractory Non-Hodgkin’s Lymphoma Undergoing Salvage Chemotherapy and Autologous Stem Cell Transplant
C. L. Hann J. Sussman McMaster University, Hamilton, ON, Canada Purpose/Objective(s): Autologous stem cell transplant (ASCT) can salvage patients with refractory or relapsed non-Hodgkin’s lymphoma (NHL). Response to salvage chemotherapy is critical to selecting patients who might benefit from ASCT. Traditional response assessment using anatomic imaging results in modest success rates. It has been proposed that assessment with functional imaging using FDG-PET may improve the selection of patients who are likely to benefit from ASCT. Materials/Methods: Prospective longitudinal cohort study of patients with relapsed or refractory aggressive histology NHL planned for salvage HDT and ASCT between June 2005 and June 2009. Patients had baseline (T1) assessment and reassessment (T2) after 2 cycles of HDT with CT and FDG PET. PET scanning was reported as positive or negative using standard criteria. Consolidative radiation was not mandated. Primary outcome is 1 year Disease Free Survival (DFS) in relationship to FDG PET. Secondary outcomes include: time to first relapse (TTFR) and site of first relapse in relationship to second PET scan. Results: Twenty-four patients entered the trial, 18 underwent transplant. Of 6 patients who did not proceed to ASCT, 5 had disease progression and, 1 had PET- T1 scan. Median follow-up after ASCT was 24 months (range: 7-60). Salvage conditioning was either DHAP (n = 8) or GDP (n = 10). Of the 18 patients transplanted 12 had negative T2 PET scans and 6 had positive T2 PET scans. At 12 months, 0/12 PET- patients relapsed, while 3/6 PET + patients failed (p = 0.0245 Fisher’s exact test). Median TTFR was 4.3 months. All relapses occurred in sites of disease identified on T2 scans. Conclusions: Our results support use of FDG PET in addition to CT in assessing patients prior to ASCT with relapsed or refractory aggressive histology NHL. Patients who have a positive PET scan after salvage chemotherapy are at a significant risk of failure
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