Management of non-Hodgkin's lymphoma

This brief review of non-Hodgkin's lymphomas emphasizes aspects of clinical research which have led to important improvements in the management of patients, and examines research questions with relevance for the future. In the intermediate- and high-grade lymphomas, strategies to intensify drug regimens have proved successful in raising rates of curative outcome. With the introduction of growth factors and peripheral stem cell transfusion to support nadir cytopenias it becomes possible to further develop dose-intense regimens. Identification and selection of poor prognostic subsets is key to the further application of these approaches, since the therapeutic ratio may be narrow and up to 50% of patients may be cured with less toxic regimens. In the low-grade lymphomas where a curative outcome is less certain, the application of intensive therapy has proved more controversial and results remain preliminary. Nevertheless, durable remissions appear achievable in advanced-stage CR patients utilizing low-dose consolidative irradiation or autologous transplantation. In contrast to intermediate- and high-grade lymphomas where intensive therapy is often reserved for responding poor-risk presentations, in low-grade lymphoma intensive therapy and consolidation is most successfully applied to good-risk patients.