Diffuse aggressive lymphomas: a curable subset of non-Hodgkin's lymphomas

The diffuse aggressive lymphomas are a major group of non-Hodgkin's lymphomas characterized by diffuse disease, in most cases, and a rapidly progressive clinical course. Until recently, the disease was fatal. Over the last 10 years, use of intermittent high-dose combination chemotherapy with non-cross-resistant drugs has significantly increased the survival time for patients with both local and advanced disease. For those with advanced disease, the most recent studies show complete response rates of 85%, complete-response relapse rates of 10%, and a 73% rate of survival for more than 3 to 5 years. The role of radiation therapy is also important, particularly in the early stages of disease. Salvage treatment with single-agent chemotherapy has achieved often impressive, but brief, responses usually of less than 1 year. Not all patients can tolerate these intensive regimens, however, and new avenues of therapy are being investigated. Various types of biologic response modifiers have been tried in patients who have been heavily pretreated. Monoclonal antibodies initially produced responses in patients with low or intermediate grade tumors, but overall results are still disappointing. Recent trials with interferons show promise especially in patients with low-grade, indolent B cell lymphomas and cutaneous T cell lymphoma. Because antitumor effects are generally of short duration, however, there is probably only a minimal role for biologic therapy in patients with aggressive lymphomas.