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Patients with inflammatory bowel disease (IBD) on immunosuppression are at risk of developing lymphoma, particularly primary gastrointestinal (GI) tract non-Hodgkin lymphoma. Primary GI Hodgkin lymphoma (HL) in this setting, however, is rare and poorly defined. Here we review the available literature and also report a patient with Crohn's disease (CD) who developed GI HL. Our search yielded 12 single case studies and 7 case series involving 22 patients published between 1978-2016. Twenty-one (91%) patients had CD, and 2 had ulcerative colitis. The median age at lymphoma diagnosis was 39 years, and 18 (78%) patients were males. HL was diagnosed at a median of 8 years after IBD detection and 2 years after commencing immunosuppression. HL had a predilection (80%) to involve the inflamed GI site and the histological subtype was mixed cellularity in 65% of cases. In-situ hybridization for Epstein-Barr virus (EBV)-encoded RNA was positive in all documented cases. HL was diagnosed in stages I, II, IV in 35%, 20% and 45% of the patients, respectively. Notably, 66% of patients with advanced disease had liver involvement. Immunosuppression was stopped in most (69%) patients at HL diagnosis. Treatment used was either chemotherapy only, surgery followed by chemotherapy, or surgery alone in 50%, 33% and 16% of cases, respectively. Four patients had an IBD flare during HL remission. Patients with IBD who develop GI HL have distinct characteristics; male sex, predominance of CD, preference to develop in inflamed sites, mixed cellularity histology, EBV positivity, and a unique spread to the liver pattern.

Background/PurposeAbout one-half of metastatic colorectal cancer (MCRC) patients are ≥70 years of age. There is uncertainty regarding the benefit patients derive from advanced chemotherapy lines. In this study, we aim to evaluate the efficacy and safety of third-line chemotherapy treatments among MCRC patients.MethodsConsecutive patients 70 years or older at the time of diagnosis of metastatic disease who received third-line chemotherapy at the Tel-Aviv Sourasky Medical Center between the years 2000–2009 were collected. Data on demographics, stage of disease, treatment lines and oncological outcomes were extracted from their medical files.ResultsOnly 34 out of 63 patients (54%) available patients received third-line treatments. The (median) age of all patients, third-line patients and the remaining patients, were similar (74.5, 74 and 75.3 years, respectively, P = NS). Following third-line treatments, only 9% had a partial response, and the disease was stable in 29% of patients seen. Thirteen weeks is the median duration of third-line treatments. Only three patients had symptomatic relief. Importantly, 15 patients (44%) required dose reduction or treatment delay due to toxicity (neutropenia or thrombocytopenia). The median survival (mOS) is 9 months for patients with first-line treatment, 19 months for second-line treatment and 37 months for third-line treatment (Log Rank