Non-Hodgkin’s Lymphoma

NON-HODGKIN’S LYMPHOMA

Non-Hodgkin’s lymphoma is a heterogeneous disease, and the clinical characteristics of non-Hodgkin’s lymphoma subsets are related to the underlying histopathologic features and the extent of disease involvement. In general, the nodular (or follicular) lym-phomas have a far better prognosis, with a median survival up to 7 years, compared with the diffuse lymphomas, which have a median survival of about 1–2 years.

Combination chemotherapy is the treatment standard for patients with diffuse non-Hodgkin’s lymphoma. The anthracy-cline-containing regimen CHOP (cyclophosphamide, doxorubi-cin, vincristine, and prednisone) has been considered the best treatment in terms of initial therapy. Randomized phase III clini-cal studies have now shown that the combination of CHOP with the anti-CD20 monoclonal antibody rituximab results in improved response rates, disease-free survival, and overall survival compared with CHOP chemotherapy alone.

The nodular follicular lymphomas are low-grade, relatively slow-growing tumors that tend to present in an advanced stage and are usually confined to lymph nodes, bone marrow, and spleen. This form of non-Hodgkin’s lymphomas, when presentingat an advanced stage, is considered incurable, and treatment is generally palliative. To date, there is no evidence that immediate treatment with combination chemotherapy offers clinical benefit over close observation and “watchful waiting” with initiation of chemotherapy at the onset of disease symptoms.