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Enteropathy Associated T-Cell Lymphoma in Celiac Disease: Can Nutrition, Chemotherapy and Reductive Surgery Influence Survival?

Celiac.com 04/15/2013 - Enteropathy-associated T cell lymphoma (EATL) is a gut cancer that often ends in death. Currently, doctors have very little idea what factors might help patients survive.

Photo: CC--GDS InfographicsThe manner in which clinical presentation, pathological features and therapies influence EATL outcome was the subject of a recent study by a team of researchers.

The research team included: G. Malamut; O. Chandesris; V. Verkarre; B.Meresse, C. Callens, E. Macintyre, Y. Bouhnik, J.M. Gornet; M. Allez; R. Jian; A. Berger; G. Châtellier; N. Brousse, O. Hermine, N. Cerf-Bensussan, and C. Cellier.

They are variously affiliated with the Université Paris Descartes, the Gastroenterology Department of Hôpital Européen Georges Pompidou, APHP, and Inserm U989 in Paris, France.

For their study, the team evaluated the medical files of 37 well-documented patients with celiac disease and T-cell lymphoma. They then analyzed lymphoma and intestinal mucosa by histopathology, multiplex PCR and intestinal intraepithelial lymphocytes phenotyping.

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Using Kaplan-Meier curves with Logrank test and Cox Model they then analyzed patient survival and prognostic factors. They found 15 patients with lymphoma-complicated non-clonal enteropathy, celiac disease, two patients with type I refractory celiac disease, and 20 patients with clonal type II refractory celiac disease. Twenty-five patients underwent surgery with resection of the main tumor mass in 22 cases.

Univariate analysis showed that non-clonal celiac disease, serum albumin levels under 21.6g/L at diagnosis, chemotherapy and surgical resection predicted good survival (p=0.0007, p

Multivariate analysis showed that serum albumin level>21.6g/L, chemotherapy and reductive surgery were all significantly associated with increased survival rates (p

The results reinforce the value of assessing celiac disease type in patients with T-cell lymphoma, and suggest that a combination of nutritional, chemotherapy and reductive surgery may improve survival rates in cases of EATL.

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