The Discussion Of The Standard Diagnosis And Therapy With Non-hodgkin's Lymphoma

Non-hodgkin's lymphomas (NHL) are a heterogeneous group of malignancies that originate in the lymphatic organs. The median age of individuals with NHL hasrisen in the last two decades from the late 50s to the early 60s. The incidence increases with age and peaks in the 80-to-85year age group. NHL is slightly more common in men than woman, with an incidence of 19.2 per 100,000 compared with 12.2 per 100,000 for women, the ratio of which is 1.6 vs 1. NHL is the sixth leading site of new cancer cases among men and women, accounting for 4% of new cancer cases. NHL is also the 8 leading cause of cancer deaths among men and the 7 among women. The incidence of NHL raise up year by year and has been paid close attention. NHL has heterogeneous disease course and complicated symptoms, which can involve any system and organ. NHL frequently present with peripheral lymphadenopathy seen at cervical part or supraclavicular fossa and is usually asympomatic unless it causes compression. The patients also present with disease at an extranodal site. The bone marrow also can been involved even with a leukemia. NHL is a disease that has different pathology, immunophenotype, biological regularity, velocity of progression of disease and therapeutic reaction. A series of 120 patients consecutively admitted to our hospital from 2002 to 2006 with the diagnosis of non-hodgkin's lymphoma were studied to discuss the correlated issues about the diagnosis and therapy.Objective: In order to discuss the correlated issues about standard diagnosis, therapy and evaluation of response of the non-hodgkin's lymphomas.Methods: A series of 120 patients consecutively admitted to our hospital from January 2002 to 2006 with the diagnosis of non-hodgkin's lymphoma were studied. Carry through clinical analyse from the distrition of the age and sexuality, the site of involvement, the initial manifestation,the pathology, laboratory andimageology investigations, the clinical staging, and the international prognostic index (IPI) subgroup, therapy and therapeutic response.Result:(1) All the cases were diagnosed according to the pathologic diagnosis. The pathologic specimens originate from three species, respectively lymphonodes or lymphoid tissues or organs, extranodal organs, and the bone marrow aspirate and trephine biopsy. Every subgroup has different initial symptoms of its own, which respectively shows the superficial lymphadenectasis, the pate and gastrointestinal symptoms and enemia and febricity.(2) The incidence of NHL in the study in middle-aged and elderly patients is higher than others, men more than women.(3) The main pathological subtypes are composed of diffuse large B-cell lymphoma (DLBCL), follicular lymphoma (FL), nasal NK/T-cell lymphoma, peripheral T-cell lymphoma (PTCL). The patiens who are diagnosed according to the WHO classification of non-hodgkin's lymphoma account for 81.7% .(4) The comparation between the bone marrow aspirate and trephine biopsy that demonstrates the bone marrow involvement shows a statistics significance (p<0.05).(5) The evaluation of clinical staging and prognoistic subgroup are both carried out again according the AJCC staging criteria and the international prognostic index(IPI). No statistics significance is found comparying the standard clinical staging and IPI subgroups with them recoreded in the cases, but which of a few cases have upper and down regulation. The reason is the unconformity of the definition of lymphonodal regions and the difference of the evidence of making a definite diagnosis of spleen or liver involved.(6) B symptoms are seen in the cases ofâ…¢andâ…£stage morn thanâ… andâ…¡stage. If the diagnosis criteria sould be strictly appliacted, a few cases wouldn't been made decisions, the course of which is less than half of a year, so theauthor consider the criteria should be agilitily applicated.(7) The therapeutic regimens of all cases are consistent with standard therpy of NHL, however, The patients who got morn than 4 courses for chemical therapy only occupy 41.7%. A statistics significance is shown comparying the overall response rate between the first and fifth chemical courses, but no significance isn't found comparing the second and fifth courses, which demonstrates the importance of the initial therapeutic effectiveness, the overall response rate increases when the courses increase ,and the standard therapy of NHL needs six courses, at least four courses.(8) There are three main questions about the standardization of the response evaluation, the first is the change of lesions lack the quantization index delineation,that is often described with the word"increase"or"decrease"in the cases, the second is the inadequacy of reexamination of the biochemical and imageology investigations, the third is that there is no follow-up so that the prostecdtive efficacy can't been evaluated.Conclusion:(1) The incidence of NHL in my study in middle-aged and elderly patients is higher than others, men more than women.(2) The bone marrow investigation is significant to make a definite diagnosis for the patients who havn't lymphonodes or lymphoid tissues involvement. The detection rate of bone marrow trephine biopsy is exactly higher than aspirate when the bone marrow is involved.(3) The study consists of the majority of WHO pathology subtypes, which also indirectly reflect the higher levels of diagnosis with NHL in our department.(4) Most cases in the study have the standard clinical staging , IPI subgroup and therapy , but no certain record of the response evaluation or lack of follow-up.(5) To think highly of the role of laboratory and imageology investigations in the diagnosis and the evaluation of therapeutic response of NHL.(6) The identification of lymph node areas concept and evidence of the final diagnosis that spleen or liver is involved guarantee the accurate evaluation of clinical staging.(7) To follow the unitive response criteria and establish the standard measurement of all measurable lesions and the standard record mode for the change of lesions guarantee the comparability of the response criteria between our department and other researchs.