Outcomes of gastrointestinal bleeding events after first-line chemotherapy in gastrointestinal-diffuse large B-cell lymphoma: a propensity-score matched analysis

Gastrointestinal bleeding (GIB) is a life-threatening complication of first-line chemotherapy in gastrointestinal diffuse large B-cell lymphoma (GI-DLBCL), yet its prognostic significance remains poorly defined. This propensity score-matched study (1:2) included 79 patients with GI-DLBCL, comparing 9 with post-chemotherapy GIB to controls without GIB. Matching was based on gender, clinical stage, Hans classification, and Eastern Cooperative Oncology Group (ECOG) performance status. Patients with GIB had worse overall survival (OS, P = 0.006) and progression-free survival(PFS, P = 0.011), with markedly lower complete (11.11% vs. 66.67%, P = 0.013) and objective (66.67% vs. 100.00%, P = 0.029) response rates. Higher baseline PET-CT parameters including gastrointestinal-metabolic tumor volume (GI-MTV, P = 0.002) and gastrointestinal-total lesion glycolysis (GI-TLG, P = 0.004) indicated GIB occurrence. In the survival analysis, high ECOG ( P = 0.032), whole-body metabolic tumor volume (Wb-MTV, P = 0.012), and total lesion glycolysis (Wb-TLG, P = 0.038) might be associated with poor OS, while high ECOG ( P = 0.008) and international prognostic index (IPI, P =0.027) were associated with poor PFS. GIB was successfully managed with conservative medical therapy in the majority of cases (77.78%), with the remainder (22.22%) requiring endoscopic hemostasis. Post-chemotherapy GIB in GI-DLBCL is associated with a poor prognosis, particularly in patients with elevated baseline PET/CT metabolic parameters indicative of high tumor burden.