[Therapy in Hodgkin disease and non-Hodgkin lymphomas].
The therapy of malignant lymphoproliferative diseases has changed many times in recent years. Treatment strategy of Hodgkin's disease is now based on risk adaptation, including not only the results of pretreatment diagnostic and prognostic factors but also the repeated PET/CT (restaging) made in the early treatment period. Possible reduction of irradiation therapy may contribute to lower the risk of secondary tumors, which are common late complications of radiochemotherapy. Autologous stem cell transplantation is the therapy of choice in chemosensitive relapsing patients. The complete remission rate today in Hodgkin's disease is around 85%. In the heterogenic group of Non-Hodgkin Lymphomas, progression of indolent lymphomas (CLL, multiple myeloma, hairy cell leukemia, cutaneous lymphomas, etc.) is slow in case of natural course. Their therapy is mostly palliative and complete remission with the latest treatment modalities is not possible. Aggressive lymphomas are characterized with rapid progression and early death without treatment.Most of them respond to chemotherapy and irradiation.With an adequate therapy, 60-70% of patients reach complete remission (CR) and 40-50% of them remain in remission. Using immune- and radioimmune therapy in indolent and aggressive NHL groups gives possibility to influence G0 tumor cells as well. Their use in combination with classic chemotherapy leads to more complete remissions and better therapy results. The introduction of routine PET/CT made the first and repeated staging of NHL more precise and contributed to more effective treatment. Using autologous stem cell transplantation in chemosensitive patients may improve outcome in selected patients.
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Semmelweis Egyetem, Altalános Orvostudományi Kar, II. Belgyógyászati Klinika, Budapest, Szentkirályi u. 46., 1088. sreter@bel2.sote.hu