[Recent progress in the chemotherapy of malignant lymphoma]

Recent progress in the chemotherapy of malignant lymphoma is described from the viewpoint of survival advantage. Malignant lymphoma is classified into the following five major categories: aggressive lymphoma, indolent B-lymphoma, Hodgkin's disease, T-lymphoblastic lymphoma and adult T-cell leukemia-lymphoma (ATL). In aggressive lymphoma of advanced stages, recent multicenter phase III studies revealed that first-generation CHOP therapy remains the best available treatment. By multivariate analysis on prognostic factors of non-ATL lymphoma patients who were treated by the second generation LSG 4 protocol, CRP and total number of involved lesions were found to be significantly unfavorable factors. In non-ATL lymphoma, mainly B-lymphoma, three risk groups (low, intermediate and high) were identified. Similarly, the International Non-Hodgkin's Lymphoma Prognostic Factors Project proposed a new predictive model for survival of aggressive lymphoma patients. Such predictive models would be very useful in the design of future chemotherapy trials for aggressive lymphoma. In advanced-stage Hodgkin's disease, about two-thirds of patients are expected to be long-term survivors, thanks to state-of-the-art chemotherapy. A recent phase III study conducted by CALGB disclosed that MOPP/ABVD and ABVD are superior to MOPP. In ATL and indolent B-lymphoma, no state-of-the-art chemotherapy has been established. In order to improve the prognosis of both diseases, innovative treatment strategies should be pursued.