胃DLBCLの診断と治療―最新の治療

The Current Treatment for Primary Gastric DLBCL

胃原発悪性リンパ腫に対しては，以前は手術療法±術後補助化学療法が選択されていたが，現在では化学療法やRTを主体とした胃温存療法が選択され，出血や穿孔などの合併症があるときに限り手術療法が検討される．限局期に対しては，R-CHOP 3コース＋IFRT，あるいはR-CHOP 6～8コースが標準治療である．進行期に対しては，R-CHOP 6～8コースが標準治療である．予後不良因子は，de novo DLBCL，non-GCB type，LDH高値，PS不良などである．近年では胃原発DLBCLに対するH. pylori除菌療法の有効性が報告されている．

　In the past, gastrectomy followed by adjuvant chemotherapy have been applied to primary gastric DLBCL（diffuse large B-cell lymphoma）as the first choice of treatment. Today, an organ-preserving approach, consisted of chemotherapy and/or radiotherapy, is favored as appropriate treatment strategy for primary gastric DLBCL, and surgery is recommended only when perforation, bleeding, or obstruction occurs, or is highly suggested to occur. The current optimal treatment strategy for localized primary gastric DLBCL is 3 cycles of R-CHOP regimen followed by radiotherapy, or 6 to 8 cycles of R-CHOP regimen. The optimal treatment strategy for advanced primary gastric DLBCL is 6 to 8 cycles of R-CHOP regimen. De novo DLBCL, non-GCB type, elevated serum LDH level, and poor performance status are predictive of poor survival. In recent years, some studies reported the efficacy of the eradication of Helicobacter pylori in primary gastric DLBCL ; however, its evidence is not enough.