Clinical practice guidelines: non-Hodgkin's lymphomas
Richard I. Fisher, MDAddress reprint requests to R.I.F., Division of Hematology/Oncology, Loyola University Medical Center, 2160 S. First Avenue, Building 54, Suite 067A, Maywood, IL 60153-5500.
Martin M. Oken, MD
Despite the common clonal origin of the non-Hodgkin's lymphomas (NHLs), their characteristic diversity contributes to the difficulty of defining comprehensive treatment regimens.OBJECTIVES
To review and compare historical and current data that define practice guidelines in the treatment of the NHLs.DISCUSSION
Early-stage, low-grade NHLs: Irradiation remains the standard treatment. Late-stage, low-grade NHLs and advanced-stage indolent lymphomas: Alkylating agents (eg, chlorambucil, cyclophosphamide) are the standard response, although recent studies suggest maintaining a vigilant, watch-and-wait course anticipatory of intervention. Some new therapies, alone or in combination, offer potential for development (eg, the chemotherapeutic agents fludarabine, 2'-deoxycoformycin, and 2-chlorodeoxyadenosine for low-grade NHLs, and bone marrow transplantation, monoclonal antibodies, and recombinant interferon-alfa for advanced-stage indolent lymphomas). Intermediate-grade aggressive and high-grade NHLs: Combination chemotherapy (ie, CHOP) is the historical treatment, plus regional irradiation, with C N S prophylaxis an additional option in high-grade lymphoblastic disease, and bone marrow transplantation an additional option in large-cell immunoblastic and small noncleaved-cell NHLs.CONCLUSIONS
Presently accepted therapies remain the mainstays in treating the NHLs; however, progressive therapeutic regimens, such as watching and waiting for intermediate-level disease progression or employing salvage, high-dose chemotherapeutic regimens, often with bone marrow transplantation, in intermediate- or high-grade disease stages, have yielded measurable successes in significant minorities of patients.