Overview of non-Hodgkin's lymphoma: biology, staging, and treatment

The Revised European-American Classification of Lymphoid Neoplasms was recently developed to address the shortcomings of the National Cancer Institute Working Formulation and to establish a common classification system that could be used internationally. The Revised European-American Classification of Lymphoid Neoplasms classification is a major improvement over previous systems and has been shown to define "real" clinical entities that can be diagnosed by expert hematopathologists. Important advances also have recently been made in the staging of lymphomas with the development of the International Prognostic Index, which accurately defines prognostic subgroups and can be used to identify patients who may benefit from more aggressive experimental treatment. With respect to treatment, there remains considerable controversy over the most effective options for patients with indolent lymphomas. However, several novel approaches appear very promising, including monoclonal antibody-based therapy, particularly radioimmunotherapy and purine analogues. In patients with aggressive lymphomas, the treatment options are less controversial. Combination chemotherapy remains the standard of care, but relapse with the development of drug resistance continues to be a problem. Recent data suggest that high-dose therapy with stem cell support may be the treatment of choice for patients with relapsed aggressive lymphomas that remain chemosensitive.