Diffuse large-cell lymphoma.

Abstract

BACKGROUND: New treatments are desperately needed to improve the results obtained using CHOP chemotherapy for patients with diffuse large cell lymphoma. In order to develop successful new strategies we need to understand why prior promising therapies have failed and to develop new testable hypotheses based on our current knowledge. PATIENTS AND METHODS: The International Non-Hodgkin's Lymphoma Prognostic Factors Index has provided us with a methodology to compare the expected prognosis of patients on different clinical trials. Many prior, apparent improvements in treatment outcome can now be attributed to the inclusion of patients with better prognoses. RESULTS: Current areas of investigation include: 1) the identification of new active drugs for the treatment of lymphoma, 2) the use of colony stimulating factors to allow dose escalation of the active myelotoxic drugs, 3) the use of strategies which may overcome the problem of resistance to chemotherapy, 4) the combination of monoclonal antibodies with combination chemotherapy and 5) ablative chemotherapy with autologous stem-cell support. CONCLUSIONS: Based on all of the available data, the North American Lymphoma Intergroup has developed the hypothesis that high-intermediate and high risk patients with aggressive lymphoma who receive full course standard induction therapy will benefit form the addition of high dose therapy and has antedated a clinical trial testing that hypothesis.