Diffuse large cell lymphoma. Prognostic factors with treatment

Five successive chemotherapy protocols for stages II, III and IV diffuse large cell lymphoma (DLCL) have resulted in identical overall survivals. Between 35% to 45% of patients survived. In a multivariate analysis employing the Weibull model 3 factors were associated with shortened survival: bulky mediastinal and/or retroperitoneal disease, elevated serum LDH and advanced age. In young patients with bulky mediastinal and/or retroperitoneal disease and high serum LDH, autologous bone marrow transplantation following high dose chemotherapy and radiation therapy (RT) as part of the initial treatment have produced more promising results. In a randomized trial, a significantly longer disease-free survival was found for patients with stages I or IE diffuse lymphomas with RT followed by adjuvant chemotherapy than with RT alone.