Conventional treatments for non-Hodgkin's lymphoma: the need for new therapies

The purpose of this article is to review the management of non-Hodgkin's lymphoma (NHL) from diagnosis through treatment, with a focus on some of the newer and highly promising treatments.

The current treatment of low-grade NHL is discussed from the oncologist's perspective for the purpose of establishing a context for the development of radioimmunotherapy.

Despite considerable progress in our understanding of the pathophysiology of NHL, both the prevalence and incidence of these diseases are increasing. Oncologists in the U.S. and Europe currently are trying to use the Revised European-American Lymphoma classification system to accurately categorize patients. Accurate diagnosis of an NHL requires physical examination and radiographic studies to assess nodal enlargement and prognostic features. Treatment for low-grade NHL during the past 30 yr has consisted of high-dose radiation and cytotoxic agents, administered alone or in combination, and high-dose therapy with stem cell transplant. Unfortunately, despite the advent of new drugs and treatment regimens, there has been little or no improvement in outcome. However, recent clinical use of monoclonal antibodies (mAbs) in patients with low-grade or transformed low-grade NHL has resulted in less toxicity than conventional treatments, as well as response rates that are comparable or superior to those achieved with chemotherapy. Therefore, interest is growing in mAbs as therapeutic alternatives for patients with low-grade NHL and those with transformed histology.

The treatment paradigm for NHL is expected to change over the next few years to include radiolabeled mAbs, administered alone or in combination with cytotoxic agents.