He thought it was a stomach problem, but it turned out to be stage IV Intestinal Lymphoma

A 55-year-old male, Ashwin Pranjapye (name changed) presented with severe abdominal discomfort, bloating, weight loss and intermittent diarrhea for 2 months. His initial blood work was normal. An imaging of abdomen revealed enlarged lymph nodes in abdomen. A screening endoscopy revealed intestinal ulcers with its biopsy confirming a diagnosis of an intestinal diffuse large B cell Lymphoma. His PET CT scan also showed involvement of disease in liver suggestive of stage IV B cell Lymphoma.

Intestinal lymphoma is a type of non-Hodgkin lymphoma (a blood cancer) that affects the lymphatic tissues (a part of the blood ecosystem) of the gastrointestinal tract. Depending on the subtype and stage, the disease may spread to lymph nodes, bone marrow, or other organs. India records an estimated 41,607 new Non-Hodgkin Lymphoma (NHL) cases and 11,230 Hodgkin Lymphoma (HL) cases annually. Lymphomas account for a significant proportion of blood cancers in the country, with NHL taking up nearly 77.5% of all lymphoma cases. Early diagnosis and timely initiation of therapy are critical, particularly in aggressive or advanced-stage disease.

Once diagnosis was confirmed, he was admitted under an adult HaemOnc unit. Considering the advanced stage of disease advanced immunotherapy with Polatuzumab and Rituximab along with standard-of-care therapy. He completed his therapy over 5 months and he continues to be in remission at his most recent follow up – one and half year from initiating his therapy.

Over the last few years, lymphoma management has evolved significantly with the increasing use of targeted immunotherapy, antibody-drug conjugates, and precision-based treatment strategies in addition to conventional chemotherapy.

“Intestinal lymphomas are often difficult to diagnose early because symptoms such as abdominal pain, bloating, altered bowel habits, or weight loss can initially appear non-specific and overlap with common gastrointestinal conditions,” said Dr Punit L Jain, Lead Consultant - Haematology, Haemato-Oncology, Bone Marrow Transplant (BMT) & CAR T-cell Therapy, Apollo Hospitals, Navi Mumbai. He further added that treatment planning today for intestinal lymphoma is increasingly personalised, and will depend on disease stage, tumour biology, patient fitness, treatment tolerance, and expected quality of life outcomes. He adds, “In this case, despite the disease being diagnosed at an advanced stage, Mr. Pranjapye responded very well to a combination treatment strategy that incorporated targeted immunotherapy.”

Besides chemotherapy, management of lymphoma also entails maintaining nutrition, monitoring treatment tolerance, infection prevention, emotional reassurance, and long-term follow-up. These steps make meaningful remission and a return in quality of life possible.

More than a year after completing therapy, he continues to remain in complete remission and has returned to normal good quality life doing his daily activities. Even though advanced lymphomas can carry a 20-30% chance of recurrence, Ashwin’s current recovery offers new hope to a lot of patients with advanced stages.