High-dose therapy for diffuse large-cell lymphoma in first remission.
Diffuse large-cell lymphoma (DLCL) is curable by first-line conventional chemotherapy in 50%-60% of patients. High-dose therapy makes no contribution to this group of patients and, if applied indiscriminately as first-line consolidation therapy, is likely to unnecessarily increase overall morbidity and mortality. Instead, recent interest has been directed towards (a) the identification of a group of patients with a poor prognosis, and (b) the intensification of first-line treatment for such patients with high-dose therapy and allied regimens. Many prognostic factors have now been standardised, while studies are progressing in the identification of newer prognostic factors, such as the molecular markers. Multi-centre randomised trials are currently in progress to determine the appropriate level of treatment for prognostic subsets, with the value of high-dose therapy being assessed for those in the worst prognostic groups.
Perry
A R
AR
University College London Hospitals, UK.
Goldstone
A H
AH
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D002986:Clinical Trials as Topic; D003131:Combined Modality Therapy; D004334:Drug Administration Schedule; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D016403:Lymphoma, Large B-Cell, Diffuse / Q000188:drug therapy* / Q000401:mortality / Q000532:radiotherapy / Q000628:therapy; D015337:Multicenter Studies as Topic; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D016032:Randomized Controlled Trials as Topic; D012074:Remission Induction; D016879:Salvage Therapy; D016896:Treatment Outcome