Interferon in the treatment of malignant lymphoma

Non-Hodgkin's lymphoma (NHL) is one of the most extensively studied human neoplasms. Oncogenes, cytogenetics, and immunologic surface markers have permitted characterization of the principal cell of origin in most instances. A new histopathologic staging classification based on prognosis has been defined (working formulation); it divides patients into favorable-, intermediate-, and poor-prognosis categories. Interpretation of therapeutic data in favorable-prognosis NHL is extremely difficult because of the disease's long natural history. Previously untreated patients tend to respond to a wide variety of agents and to radiation, although these modalities do not have a major impact on survival. Poor-prognosis NHL is usually treated with combination chemotherapy, which results in cure of 30% to 60% of patients. New approaches employing high-dose chemoradiotherapy and autologous marrow infusion have been investigated as salvage therapy. Recombinant interferon alpha has been tested in a large number of patients with previously untreated NHL, and some antitumor effect has been noted, especially in those with favorable-prognosis disease. In patients with poor-prognosis disease, such as diffuse large-cell lymphoma, a composite series showed that 9 of 51 patients had transient responses. The response rate in favorable-prognosis lymphomas approximated 50%, indicating that favorable-prognosis lymphomas have intrinsic biologic sensitivity to interferons and should be further explored for that effect and for possible synergism between interferons and cytotoxic therapy.