Practical approaches to the management of aggressive lymphomas in the community practice

Because of the variety of pathologic classifications for non-Hodgkin's lymphomas, it became necessary to develop a new system that incorporated the biologic, immunologic, and morphologic characteristics of these lymphomas. The National Cancer Institute (NCI) developed the Working Formulation that now classifies lymphomas into low, intermediate, and high grade. Physicians should be aware of these changes so that they can communicate with expert pathologists who speak the same language. Staging procedures to evaluate non-Hodgkin's lymphoma are similar to those used to evaluate Hodgkin's disease. The major advance in the treatment of this condition in the past few years has been in diffuse large cell lymphoma. Primary treatment programs using first-generation chemotherapy include CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone), which is easy to administer and has a high complete remission (CR) rate of 51% and a 2-year survival of 39%. CHOP is about equal in activity to other first-generation regimens and remains the most frequent regimen to treat diffuse large cell lymphomas. Second-generation regimens were devised to increase the remission rate. COP-BLAM (cyclophosphamide, vincristine, prednisone, bleomycin, doxorubicin, procarbazine), M-BACOD (methotrexate, bleomycin, doxorubicin, cyclophosphamide, vincristine, dexamethasone), and ProMACE-MOPP (prednisone, methotrexate, doxorubicin, cyclophosphamide, etoposide, mechlorethamine, vincristine, procarbazine, prednisone) have produced CRs in excess of 70% and have demonstrated an increase in survival that has been associated with a concomitant increase in toxicity.(ABSTRACT TRUNCATED AT 250 WORDS)