[Therapy of high-grade non-Hodgkin's lymphoma]

Complete remission can be achieved in 50 to 80% of adult patients with high-grade non-Hodgkin's lymphoma [2, 33]. The average disease-free survival is 40 to 50% at 3 years and 30 to 35% at 5 years [2, 6]. The diagnosis of non-Hodgkin's lymphoma should still be based on the histopathological and immunohistochemical evaluation of a surgical biopsy specimen. Initial staging involves radiological evaluation of tumor mass and lymph-node involvement, bone marrow biopsy, conventional laboratory investigations including LDH and beta 2-microglobulin, as well as chromosome analysis and molecular biology. These methods are also used for monitoring of patients during and after therapy. Established negative risk factors include age over 60 years, clinical stage III or IV, involvement of more than 1 extranodal site, a WHO performance status of 2 or more, and an elevation of the LDH. CHOP remains the standard chemotherapy. Aggressive regimens of the second and third generations, as well as dose-intensification have failed to prove a superior effect on overall survival [7]. Full-dose treatment on schedule can be facilitated by supportive therapy with cytokines such as G-CSF or GM-CSG. High-risk patients may have a favorable outcome after myeloablative chemotherapy and radiation followed by autologous or allogeneic bone marrow transplantation. Co-ordinated planning between conventional centers and transplant units should lead to a risk adjusted treatment of the individual patient.