[Chemotherapy for malignant lymphoma in Western countries and Japan]

Nationwide epidemiological studies have disclosed that lymphoid malignancies in Japan are markedly different from those in Western countries; they are less frequent in indolent B-lymphoma and Hodgkin's disease and more frequent in T-cell lymphoma, particularly adult T-cell leukemia-lymphoma (ATL). In 1978, the Lymphoma Study Group (LSG) of Japan started multicenter clinical trials for malignant lymphoma. Since then various kinds of phase II and III studies for aggressive lymphoma, Hodgkin's disease, ATL, T-lymphoblastic lymphoma, acute lymphoblastic leukemia and multiple myeloma have been conducted by the LSG. Based on the results of clinical trials conducted in Western countries and the LSG, the state of the art of chemotherapy for malignant lymphoma is described. In aggressive lymphoma of advanced stages, after establishment of CHOP therapy (1st generation), better results were reported in Western countries for single institute phase II studies of non-cross resistant alternating multiagent chemotherapy (2nd generation) and high relative dose intensity chemotherapy (3rd generation). However, recent multicenter phase III studies, comparing CHOP with 3rd generation regimens, revealed that CHOP remains the best available treatment, because of similar failure-free and overall survival with lower cost and lower severe toxicity.