Treatment of patients with aggressive lymphomas: an overview

The treatment of aggressive lymphomas has progressed to the point that over 90% of the patients with localized disease, around 50% of the patients with advanced disease, and perhaps up to 25% of relapsing patients may enjoy long-term, disease-free survival. Several studies have documented that primary combination chemotherapy with or without involved-field radiation therapy is capable of curing 90% or more of the patients with clinically staged, localized disease. Results with primary radiation therapy in such patients are not nearly as good, even in those who undergo laparotomy staging. The management of advanced-stage disease is more controversial. Although combination chemotherapy is the treatment of choice, there is debate about whether the impressive results with the latest regimens, such as MACOP-B, COP-BLAM III, and ProMACE-CytaBOM, which appear to be curative for around 60% or more of advanced-stage patients, are really superior to CHOP, the most widely used program, which cures about 30% or so of the patients. A major idea that is guiding the development of new treatment programs is augmenting the dose intensity of the treatment. This notion is fueled not only by the demonstrated dose-response relationships that have been documented by Hryniuk and colleagues in other tumor types, such as cancers of the breast, ovary, and colon, but also by recent experience in the salvage therapy of relapsed aggressive lymphoma. Formerly a universally fatal disease, relapsed aggressive lymphoma now appears to be responsive to high-dose chemotherapy with or without radiation therapy followed by autologous or allogeneic bone marrow or peripheral blood stem cell reconstitution.(ABSTRACT TRUNCATED AT 250 WORDS)