[Aggressive lymphomas]

The term "aggressive lymphoma" applies to the intermediate severity and high malignancy lymphomas of the international classifications. Despite their heterogeneity, the lymphomas of this group should be cured by modern treatments. The therapeutic approach depends on the presence or absence of adverse prognostic factors. When these factors are absent cure can be obtained in 80 to 90% of the cases by chemotherapy or chemo-radiotherapy. The basic treatment rests on chemotherapy adjusted to the severity of the disease. In its least severe forms the different chemotherapeutic combinations available have about the same effectiveness, and it is rational to choose the least toxic of them. Intensive treatments are reserved to patients with several factors of poor prognosis. In such cases, complete remission rates may be close to 65%, but the percentage of long-term survival is only 40%, and new therapeutic approaches are required. At present, in addition to intensified conventional therapy made possible by growth factors, the possibility or early intensification with haematopoietic stem cells autografts is being studied. Intensive treatments can only be given to young subjects. Lymphoblastic and Burkitt's must be approached differently when medullary or meningeal tissues are invaded.