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Intestinal Non-Hodgkin's Lymphoma

Department of Medicine A, Hematology/Oncology, University of Muenster, Muenster, Germany

To the Editor:

With great interest we read the recent article by Daum et al,¹ reporting on their prospective study on intestinal non-Hodgkin's lymphoma and stressing the difference in treatment results between intestinal T-cell (ITCL) and B-cell lymphomas (IBCL), showing a significantly better survival for IBCL.

The authors emphasize a possible bias because of their scientific interest in celiac disease and subsequently in enteropathy-associated T-cell lymphoma, which therefore may be over-represented in their study. Another bias might be the inclusion of patients with involvement of more than one section of the intestine.

In our publication on primary gastrointestinal non-Hodgkin's lymphoma, we stressed importance of exactly defining the region of origin within the intestine instead of grouping several together since we could demonstrate clear differences in age, sex, histologic subgroups, and survival depending on the primary site.² This is underlined in Figure 1 (data for small intestine [SI] only) and Figure 2 (combined data for SI and ileocoecal region [ICR]).

View larger version (19K): [in this window] [in a new window]   Fig 1. Survival in lymphoma of the small intestine stratified by histologic subtypes; stages I and II.

View larger version (21K): [in this window] [in a new window]   Fig 2. Survival in lymphomas of the small intestine and the ileocoecal region stratified by histologic subtypes; stages I and II.

We therefore strongly recommend that reports on intestinal lymphomas distinguish (1) between the site of origin and (2) between ITCL (especially enteropathy-associated T-cell lymphoma) with or without active enteropathy.

Authors' Disclosures of Potential Conflicts of Interest

The authors indicated no potential conflicts of interest.

REFERENCES

1. Daum S, Ullrich R, Heise W, et al: Intestinal non-Hodgkin's lymphoma: A multicenter prospective study from the German study group on intestinal non-Hodgkin's lymphoma. J Clin Oncol 21:2740-2746, 2003[Abstract/Free Full Text]

2. Koch P, del Valle F, Berdel WE, et al: Primary gastrointestinal non-Hodgkin's lymphoma, I: Anatomical and histological distribution, clinical features, and survival data of 371 patients registered in the German Multicenter Study (GIT NHL 01/92). J Clin Oncol 19:3861-3873, 2001[Abstract/Free Full Text]

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Related Reply

• In Reply:
  S. Daum, R. Ullrich, and M. Zeitz
  JCO 2004 22: 2753-2754 [Full Text]

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