Current therapeutic paradigm for the treatment of non-Hodgkin's lymphoma

Patients with indolent non-Hodgkin's lymphoma may be treated with various approaches ranging from deferred initial therapy (watch and wait) to single-agent alkylating agents, radiation therapy, or combination chemotherapy. None of these approaches have produced curative results. Clearly, innovative treatment strategies are needed. The use of interferon, monoclonal antibodies with or without radioisotopes, purine analogues, and even high-dose therapy with stem-cell rescue are under investigation. Based on the fact that fewer than 40% of advanced-stage, aggressive non-Hodgkin's lymphoma patients are cured with cyclophosphamide/doxorubicin/vincristine/prednisone chemotherapy, the best approach for any patient is an experimental one. Examples include: (1) increasing the dose intensity of drugs used in standard regimens; (2) preventing the development of drug resistance; (3) combining monoclonal antibodies with chemotherapy; or (4) autologous stem-cell transplantation as a rescue from marrow-ablative chemotherapy. If a patient is not eligible or does not wish to participate in a clinical trial, cyclophosphamide/doxorubicin/vincristine/prednisone, as inadequate as it is, remains the gold standard.