Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Aug 15, 2022; 14(8): 1552-1561
Published online Aug 15, 2022. doi: 10.4251/wjgo.v14.i8.1552
Duodenal-type follicular lymphoma more than 10 years after treatment intervention: A retrospective single-center analysis
Makoto Saito, Akio Mori, Shihori Tsukamoto, Takashi Ishio, Emi Yokoyama, Koh Izumiyama, Masanobu Morioka, Takeshi Kondo, Hirokazu Sugino
Makoto Saito, Akio Mori, Shihori Tsukamoto, Takashi Ishio, Emi Yokoyama, Koh Izumiyama, Masanobu Morioka, Takeshi Kondo, Blood Disorders Center, Aiiku Hospital, Sapporo 064-0804, Japan
Hirokazu Sugino, Department of Cancer Pathology, Hokkaido University, Faculty of Medicine, Sapporo 060-8638, Japan
Author contributions: Saito M designed this study; Mori A, Tsukamoto S, Ishio T, Yokoyama E, Izumiyama K, Morioka M, and Kondo T took part in drafting the article; Sugino H was involved in the pathological procedure; all authors collected and analyzed the patient’s clinical data and agreed to be accountable for all aspects of the work.
Institutional review board statement: This study was reviewed and approved by the Aiiku Hospital Clinical Research Review Board (Sapporo).
Informed consent statement: All patients provided written informed consent.
Conflict-of-interest statement: There are no conflicts of interest with respect to the research, authorship, and/or publication of this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Makoto Saito, MD, PhD, Chief Doctor, Blood Disorders Center, Aiiku Hospital, Chuo-ku, 4 Minami 25 Nishi, Sapporo 064-0804, Japan. ikyoku@aiiku-hp.or.jp
Received: November 27, 2021
Peer-review started: November 27, 2021
First decision: January 23, 2022
Revised: January 19, 2022
Accepted: July 26, 2022
Article in press: July 26, 2022
Published online: August 15, 2022
Processing time: 256 Days and 7.7 Hours
Abstract
BACKGROUND

Duodenal-type follicular lymphoma (D-FL) has been recognized as a rare entity that accounts for approximately 4% of primary gastrointestinal lymphomas. D-FL follows an indolent clinical course compared with common nodal FL and is generally considered to have a better prognosis. Therefore, the “watch and wait” approach is frequently adopted as the treatment method. Alternatively, there is an option to actively intervene in D-FL. However, the long-term outcomes of such cases are poorly understood.

AIM

To clarify the clinical outcomes after long-term follow-up in cases of D-FL with treatment intervention.

METHODS

We retrospectively analyzed patients who met the following criteria: the lesion was confirmed by endoscopy, the diagnosis of D-FL was confirmed histopathologically, and the patient was followed-up for more than 10 years after the intervention at our center.

RESULTS

We identified 5 cases of D-FL. Two patients showed a small amount of bone marrow involvement (Stage IV). Rituximab was used as a treatment for remission in all 5 patients. It was also used in combination with chemotherapy in 2 Stage IV patients as well as for maintenance treatment. Radiation therapy was performed in 2 cases, which was followed by complete remission (CR). Eventually, all 5 patients achieved CR and survived for more than 10 years. However, 3 patients experienced recurrence. One patient achieved a second CR by retreatment, and in another case, the lesion showed spontaneous disappearance. The remaining patient had systemic widespread recurrence 13 years after the first CR. Biopsy results suggested that the FL lesions were transformed into diffuse large B-cell lymphoma. The patient died 4 years later despite receiving various chemotherapies.

CONCLUSION

In this study, the treatment for patients of D-FL in Stage IV was successful. In the future, criteria for how to treat “advanced” D-FL should be established based on additional cases. This study of patients with D-FL indicates that whole-body follow-up examinations should continue for a long time due to a fatal recurrence 13 years after reaching CR.

Keywords: Duodenal-type follicular lymphoma; Treatment; Long-term follow-up; Radiation; Rituximab; Chemotherapy

Core Tip: Since duodenal-type follicular lymphoma (D-FL) progresses more indolently than common nodal FL, the “watch and wait” approach is frequently used without intervention. To elucidate the clinical assessments of long-term follow-up in cases of D-FL with treatment intervention, we retrospectively examined 5 D-FL patients for more than 10 years after treatment at our center. All 5 patients eventually achieved complete remission and survived for a long period. However, 3 patients experienced recurrence, and 1 patient died of the primary disease 21 years after first onset. In the future, it will be necessary to establish criteria for how to treat Stage IV “advanced” D-FL.