[Treatment of intermediate-grade non-Hodgkin lymphoma in adults]

In the past 20 years increasing incidence 15/100,000 of non Hodgkin's lymphoma (NHL) has been observed. Despite their heterogeneity, intermediate grade NHL are potentially cured with chemotherapy. Advances in our understanding of the biology and in their treatment have been made. Factors, such as age, stage, performance status, and predicting treatment outcome are useful parameters to decide on the intensity of chemotherapy. With conventional treatment, 80% of the patients without adverse prognostic factors can be cured. For patients with at least two adverse factors only 40% are long term survivors. Different dose-escalation chemotherapy regimens have been tested including autologous hematopoietic stem cell transplantation (ASCT). At the present time, no clear improvement has been seen in randomized trial when intensification is made after obtention of complete remission. However, for relapsing patients ASCT can provide 46% disease free survival in patients still sensitive to salvage chemotherapy and ASCT is the therapy of choice under 60 years old. New development of technology with mobilized peripheral stem cell (PBPC) allowed to develop early intensive treatment with acceptable toxicity. Encouraging results have been reported and tested in randomized trial in patients less than 60 years old. Improvement of the treatment of older patients remains problematic considering that chemotherapy can increase hematopoietic and non hematopoietic lethal complications reducing the chance to achieve complete remission.