Chemotherapy of malignant lymphomas

Chemotherapy of malignant lymphomas has entered the exciting era in which cure can be expected in a large portion of untreated patients, even those with advanced-stage disease. The major obstacle to complete remission is selection and overgrowth of a permanent, drug-resistant, neoplastic cell population. For this reason, a number of investigators have tested the efficacy of two or more non-cross-resistant regimens delivered in alternating fashion. In stage IV Hodgkin's disease, the MOPP-ABVD program increases the cure rate by 15% to 20% compared with MOPP alone. With intensive polydrug regimens, at least 50% of patients with diffuse large-cell non-Hodgkin's lymphomas (NHL) can now be cured. The risk of treatment-induced acute leukemias as well as sterility can be avoided or greatly decreased with drug combinations not including procarbazine HCI and alkylating agents. Effective salvage regimens for lymphomas resistant to primary chemotherapy have been described in part for Hodgkin's disease; a number of second-line treatments can probably cure 20% to 25% of MOPP-resistant patients. Encouraging results that require confirmation have also been reported in the treatment of relapsing NHL with drug combinations including cisplatin (Platinol), cytosine arabinoside, etoposide (VP-16), ifosfamide, and amsacrine. Salvage drug therapy combined with autologous bone marrow transplantation appears promising but, at present, remains experimental.