Current treatment options in aggressive lymphoma.
The overall percentage of patients achieving long-term remissions in aggressive non-Hodgkin's lymphoma (NHL) using CHOP or CHOP-based primary chemotherapy is only 40%. Much effort has therefore been concentrated on developing strategies to improve this figure. More intensive variants of CHOP chemotherapy, such as multi-agent "third-generation" regimens, have failed to improve long-term survival, and are also associated with increased toxicity. Hence, there is a need for improved treatment regimens, both as primary therapy and for patients in first and subsequent relapse. This need is most acute in elderly patients (> 60 years of age), who comprise more than 50% of NHL cases and who may not be able to tolerate subsequent intensive chemotherapy at relapse. Approaches currently being examined to improve outcome include: the use of clinical, histological and molecular prognostic factors to establish a patient's risk group, and so define those patients most likely to benefit from early aggressive therapy; the inclusion of high-dose therapy and autologous transplantation; and the integration of novel therapies, such as immunotherapy and radioimmunotherapy, into existing treatment strategies. The impact of these approaches on the treatment of diffuse, large B-cell lymphoma and mantle cell lymphoma is discussed below.
Marcus
Robert
R
Consultant Haematologist, Addenbrooke's Hospital, Cambridge, CB2 2QQ, UK. Robert.Marcus@addenbrookes.nhs.uk
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D006801:Humans; D008223:Lymphoma / Q000401:mortality / Q000628:therapy*; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy; D020522:Lymphoma, Mantle-Cell / Q000628:therapy; D016399:Lymphoma, T-Cell / Q000628:therapy; D016499:Radioimmunotherapy; D016019:Survival Analysis