New treatment strategies for aggressive lymphoma

For the past three decades chemotherapy with CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) has been the standard treatment for aggressive non-Hodgkin's lymphoma (NHL), with only minor changes having been made to the regimen to increase its efficacy. Recently, however, clinical trials have shown significant improvements in outcome in aggressive NHL by showing the benefit of using dose-dense or accelerated schedules as well as by adding rituximab to the standard CHOP regimen. Maintaining the relative dose intensity (that is, delivering the full dose of the chemotherapy on schedule) is an important principle in achieving optimal outcomes in the treatment of NHL. Clinical studies have shown that dose reductions and delays result in poorer outcomes in patients with NHL, and in many cases greater dose intensity appears to result in greater overall and progression-free survival. In particular, compressing the delivery of the standard 21-day CHOP doses into a dose-dense 14-day schedule has been shown to increase event-free survival, overall survival, or both in patients with diffuse large B-cell lymphoma. Consequently, the CHOP-14 regimen (in which the dose intensity is 50% greater than that of the standard regimen) has been adopted by many oncologists for the treatment of aggressive NHL.