American Journal of Cancer

, Volume 4, Issue 3, pp 145–158 | Cite as

Novel Approaches to the Management of Non-Hodgkin Lymphoma

Leading Article
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Abstract

The rate of increase in the incidence of non-Hodgkin lymphoma (NHL) is outstripping that of other cancers. NHL is increasingly being treated in the context of immune compromise due to age or concomitant disease. Whilst most NHLs fall into the clearly aggressive and indolent categories, it is clear that distinction of less common entities such as Burkitt and mucosa-associated lymphoid tissue (MALT) lymphomas is essential for appropriately targeted treatment. Better diagnostic tools including the WHO histopathological criteria and quality imaging systems for CT, magnetic resonance imaging (MRI), and positron emission tomography (PET) scanning have facilitated accurate disease classification. Prognostic indices have been validated for both aggressive and indolent disease, and multidisciplinary input into diagnosis and management has proved beneficial.

Aggressive disease can be cured in most patients. Survival advantages have been shown with modification of the CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone) regimen including acceleration to a 14-day cycle supported by granulocyte colony-stimulating factor and combination with rituximab. Indolent disease remains incurable for the majority of patients but the therapeutic armamentarium has widened considerably. Radiotherapy has hitherto provided synergistic support for standard treatment; the introduction of radioimmunoconjugates has extended its curative potential to include advanced disease. Salvage with the potential for cure has become attainable in relapsed and refractory disease.

Autologous transplantation can now safely be performed in older patients because of more rapid engraftment with the use of mobilized peripheral stem cells, and better supportive care. The development of reduced-intensity conditioning for allograft has resulted in a significant reduction in transplant-related mortality when compared with the conventional approach. Allograft is no longer only for the young and fit. Exploitation of a graft versus lymphoma effect with donor lymphocyte infusion has been demonstrably effective, particularly in indolent disease.

Molecular strategies and vaccine therapies have been successful in early trials. Antiangiogenic agents and proteasome inhibitors show potential. Advances in treatment have been attained with both rigorous application and extension of historically successful treatment, and with development of experimental approaches in vitroand in vivo.Introduction of genomic and proteomic assessment into routine clinical practice will undoubtedly impact on the management of NHL in the future.

Keywords

Follicular Lymphoma Fludarabine Mantle Cell Lymphoma Alemtuzumab Overall Response Rate 

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Copyright information

© Adis Data Information BV 2005

Authors and Affiliations

  1. 1.Academic Department of HaematologyUniversity College LondonLondonEngland

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