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Background <p>Standard R-CHOP immunochemotherapy for diffuse large B-cell lymphoma (DLBCL) with gastrointestinal (GI) involvement is associated with an increased risk of severe GI complications, including perforation and acute hemorrhage. This study evaluates a modified treatment regimen aimed at reducing these risks without compromising therapeutic efficacy.</p> Methods <p>We retrospectively analyzed 65 DLBCL patients with GI involvement. Group 1 (<i>n</i> = 33) received a 3-day pre-phase dexamethasone (DEX) followed by a fractionated R-CHOP regimen (cyclophosphamide, doxorubicin, and vincristine split on days 1 and 4) in cycle 1, then transitioned to standard R-CHOP from cycle 2 onwards. Group 2 (<i>n</i> = 32) received six cycles of standard R-CHOP without pretreatment.</p> Results <p>No treatment-related GI perforation or acute hemorrhage occurred in Group 1, compared with an incidence of 18.7% in Group 2 (<i>p</i> = 0.03). There were no significant differences in overall response rate (84.9% vs. 82.7%), 5-year progression-free survival (73.0% vs. 68.1%; <i>p</i> = 0.62), or 5-year overall survival (83.7% vs. 78.0%; <i>p</i> = 0.58). Hematologic toxicities were comparable between groups, and no treatment-related deaths occurred in Group 1.</p> Conclusion <p>A pre-phase of dexamethasone followed by fractionated R-CHOP in the first cycle, before transitioning to standard R-CHOP, significantly reduces the incidence of GI complications while preserving therapeutic efficacy in DLBCL patients with GI involvement. This approach offers a safer induction strategy without compromising survival outcomes.</p>

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Safety and efficacy of a pre-phase with dexamethasone followed by fractionated R-CHOP in diffuse large B-cell lymphoma patients with gastrointestinal involvement at diagnosis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年1月23日

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  • Ke Cui,
  • Jiangbo Wan,
  • Zhichao Li,
  • Jie Zhao,
  • Yun Qin,
  • Siguo Hao,
  • Fang Huang

摘要

Background

Standard R-CHOP immunochemotherapy for diffuse large B-cell lymphoma (DLBCL) with gastrointestinal (GI) involvement is associated with an increased risk of severe GI complications, including perforation and acute hemorrhage. This study evaluates a modified treatment regimen aimed at reducing these risks without compromising therapeutic efficacy.

Methods

We retrospectively analyzed 65 DLBCL patients with GI involvement. Group 1 (n = 33) received a 3-day pre-phase dexamethasone (DEX) followed by a fractionated R-CHOP regimen (cyclophosphamide, doxorubicin, and vincristine split on days 1 and 4) in cycle 1, then transitioned to standard R-CHOP from cycle 2 onwards. Group 2 (n = 32) received six cycles of standard R-CHOP without pretreatment.

Results

No treatment-related GI perforation or acute hemorrhage occurred in Group 1, compared with an incidence of 18.7% in Group 2 (p = 0.03). There were no significant differences in overall response rate (84.9% vs. 82.7%), 5-year progression-free survival (73.0% vs. 68.1%; p = 0.62), or 5-year overall survival (83.7% vs. 78.0%; p = 0.58). Hematologic toxicities were comparable between groups, and no treatment-related deaths occurred in Group 1.

Conclusion

A pre-phase of dexamethasone followed by fractionated R-CHOP in the first cycle, before transitioning to standard R-CHOP, significantly reduces the incidence of GI complications while preserving therapeutic efficacy in DLBCL patients with GI involvement. This approach offers a safer induction strategy without compromising survival outcomes.