Management of intermediate-grade lymphomas.
Intermediate-grade lymphomas are defined by the Working Formulation to include four histologic subgroups: follicular large-cell, diffuse small-cleaved-cell, diffuse mixed small- and large-cell, and diffuse large cell (Groups D, E, F, and G, respectively). [1] These four histologic subtypes were found to have "intermediate" median and overall survival features based on outcome analysis of 1,153 patients with non-Hodgkin's lymphomas. Clinicians, however, have come to "expect" different criteria for intermediate-grade lymphomas. Those criteria include an aggressive growth rate, a high risk of fatality early in the disease course without treatment, and a potential for cure using CHOP chemotherapy (cyclophosphamide [Cytoxan, Neosar], doxorubicin [Adriamycin], vincristine [Oncovin], and prednisone). The expectations are summarized by overall survival graphs demonstrating an initial steep curve, followed by a discernible change in slope, and ending in a relatively flat line or plateau representing the proportion of patients cured. [2] That is, an intermediate-grade lymphoma should be an aggressive disease that is potentially curable with CHOP. In that respect, the Working Formulation is partly successful, but not by design.
Miller
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Arizona Cancer Center, University of Arizona, Tucson, USA.
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology; D011241:Prednisone / Q000008:administration & dosage; D011379:Prognosis; D016879:Salvage Therapy; D015996:Survival Rate; D014750:Vincristine / Q000008:administration & dosage
D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011241:Prednisone