Clinical practice guidelines: non-Hodgkin's lymphomas.

Abstract

BACKGROUND: 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 CNS 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.