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In the case of synchronous lesions originating in the gastrointestinal tract, staging refers to the characteristics of the most advanced lesion. Note that the Lugano system does not include a stage III.
1Any subtype of tumor extension (T1 to T4) or nodal (N0 to N3) or metastatic (M0 to M2) involvement;
2Non-contiguous gastrointestinal involvement refers to the presence of lymphoma in more than one gastrointestinal site with segments of discontinuity that are free of disease (such as the involvement of the stomach and rectum, with a free small intestine and bowel);
3Including the non-contiguous involvement of the peritoneum. References for the 4 staging systems are given in the main text.
Table 6 Tumor-node-metastasis staging system qualifiers
Extension of lymphoma not established
No evidence of primary lymphoma
Nodal involvement not evaluated
No evidence of nodal involvement
Dissemination of lymphoma not evaluated
No evidence of lymphoma dissemination
Bone marrow infiltration not evaluated
No evidence of bone marrow infiltration
Table 7 International prognostic index for aggressive B-cell lymphomas
> 60 yr
Ann arbor stages III or IV
High tumor burden and activity
Increased serum lactate dehydrogenase
Poor performance status
ECOG ≥ 2
Two or more extranodal sites
The International Prognostic Index is calculated by adding 1 point for each adverse risk factor. ECOG: Eastern Cooperative Oncology Group performance status scale.
Table 8 Chemotherapy treatment options in American and European guidelines