Over the past few decades, the occurrence of adult onset non-Hodgkin's lymphoma has significantly increased. The patient population involved is very heterogeneous, with different clinical and morphological manifestations. In addition to the most typical nodal involvement, extra-nodal manifestations are also frequent, affecting, most often, the gastrointestinal tract, the central nervous system and the skin. The treatment strategy for non-Hodgkin's lymphoma has changed over the past decade: chemo-immunotherapy has largely taken over surgical intervention, the dominant treatment option of the past.
Methods: The authors present their experience with 48 patients with non-Hodgkin's lymphoma, affecting the gastrointestinal tract, treated in Kaposvár, in the Kaposi Mór Teaching Hospital and in Gyula, in the Pándy Kálmán County Hospital. Demography: 27 female, 21 male; mean age: 67.8 years. Localization, pathological classification and the international prognostic index (IPI) have been analysed and correlated with the clinical response to different therapeutic strategies.
Results: The most frequently involved GI organ was the stomach ( n = 26), with the dominant histological type of diffuse large B-cell lymphoma. Fourty-six patients received chemo-immunotherapy, 6 received radiotherapy, 3 patients were primarily treated with Helicobacter pylori eradication therapy, and 4 patients were referred for stomach resection. A complete remission was achieved in 68% of the patients, a partial remission in 13%, while 19% did not show clinical response. Based on the international prognostic index, the majority of the patients fulfilled criteria of low or high intermediate risk categories, with an IPI average of 2.68. Patients with upper gastrointestinal tract involvement carried the best prognosis (IPI: 2.0); at the same time, patients with stomach lymphoma achieved the highest rate of remission (73%).
Conclusions: With chemo-immunotherapy the chances of a complete remission have significantly improved over the past decade, thus a significant portion of non-Hodgkin's lymphomas involving the gastrointestinal tract can be cured. IPI index represents the most recognised indicator for assessing the prognosis of non-Hodgkin's lymphoma. Patients who achieved complete remission had the lowest prognostic index in this cohort; nevertheless, numerous data indicate that factors other than the IPI can also have an impact on patients' response to treatment.