Perforation of the small intestine as an early complication of R-CHOP immunochemotherapy in patients with DLBCL — a report of two cases

Abstract

Diffuse large B-cell lymphoma (DLBCL) is the most common lymphoma in adult patients. The R-CHOP regimen (rituximab in combination with cyclophosphamide, doxorubicin, vincristine, and prednisone) is the gold standard of the treatment for patients with DLBCL. Different adverse events are observed during this treatment, for example: adverse events related to the infusion (cytokine release syndrome, tumor lysis syndrome), hematologic events, cardiovascular events, infections. Perforations of the stomach and small intestine are rare but life-threatening complications of the R-CHOP immunochemotherapy. We present two patients with DLBCL, who were treated with R-CHOP regimen. Both had perforation of the small intestine shortly after first cycle. One of them underwent partial resection of the small intestine, another had enterorhaphy. Intraoperatively no neoplastic infiltration of gastrointestinal tract was noted. After recovery the patients continued R-CHOP immunochemotherapy achieving complete remission.