The present status of therapy for patients with aggressive non-Hodgkin's lymphoma

The aggressive non-Hodgkin's lymphomas include some of the malignancies most frequently cured with chemotherapy. However, not all patients are cured, and the best treatment approach remains uncertain. The most common aggressive non-Hodgkin's lymphomas are diffuse large-cell lymphoma and immunoblastic lymphoma. Most recent studies suggest no useful difference between these two groups. When these lymphomas are localized at presentation they are highly curable. Earlier studies showed that radiotherapy alone had a high relapse rate. Chemotherapy alone has been found to have an excellent cure rate, but when followed by radiotherapy, the amount of chemotherapy can be reduced with the same good result. A number of chemotherapy regimens have been shown to cure approximately 50% of patients with disseminated large-cell lymphoma. It appears that a number of regimens including m-BACOD, MACOP-B, LNH-84, ProMACE-CytaBOM, CAP-BOP, COP-BLAM, F-MACHOP, and perhaps full-dose CHOP achieve similar results when prognostic factors are taken into account. Currently the most important area for therapeutic research (unless new drugs are found) is in identifying those patients likely to be cured with our present treatments and those patients for whom alternative therapies such as bone marrow transplantation need to be considered as part of the primary treatment. This is true not only for large-cell lymphoma but also for the less common aggressive non-Hodgkin's lymphomas such as lymphoblastic lymphoma, small noncleaved-cell lymphoma, and peripheral T-cell lymphoma.