[Treatment of high risk non-Hodgkin's lymphoma]

Among malignant disease, the non-Hodgkin's lymphomas (NHL) are a diverse group of lymphoid neoplasms that display a wide spectrum of clinical, morphologic, immunologic, and molecular features. Currently the NHL are divided into three groups based on their clinical behavior: 1) indolent, 2) aggressive, and 3) highly aggressive. Among the groups, many patients with aggressive NHL is curable with current combination chemotherapy, however fractions of patients will relapse, and resistant disease remains a problem. It would be valuable to identify those patients with a particularly poor prognosis when treated with a standard regimen so that alternative therapies could be tested. A number of risk factors distinguish patients with a distinct natural history and probability of response to therapy. Recently, international index identifies subsets of patients who are likely to do well or unlikely to benefit from standard regimens and younger high-risk patients are candidates for more intensive experimental therapy. A major idea that is guiding the development of new treatment programs is augmenting the dose intensity of the treatment. The development of colony-stimulating factors allow us to increase intensity of chemotherapy. However, it must be confirmed that such therapy really improve the survival of the patients with high risk NHL. Formerly a universally fatal disease, relapsed aggressive lymphoma now appears to be responsive to combinations of non-cross resistant antineoplastic drugs or to high-dose chemotherapy with or without rediation therapy followed by autologous or allogeneic bone marrow or peripheral blood stem cell transplantation.(ABSTRACT TRUNCATED AT 250 WORDS)