Chemotherapy of the non‐Hodgkin's lymphomas

Abstract

A multiplicity of antineoplastic agents are active in the treatment of non‐Hodgkin's lymphomas. In addition to a high order of responsiveness following single drug therapy, combination chemotherapy is usually even more efficacious in inducing complete remissions. The utility of the Rappaport classification for clinicians lies primarily in its ability to categorize patients with non‐Hodgkin's lymphoma into favorable and unfavorable prognostic groups. Favorable histology lymphomas include the nodular poorly differentiated lymphocytic, mixed histiocytic lymphocytic and diffuse well‐differentiated lymphoma. Since the natural history of these diseases is quite long, it is difficult to evaluate the impact of chemotherapy on survival. Thus, disease‐free survival appears to be the more useful parameter in the evaluation of any new program. It is difficult to demonstrate an advantage for aggressive therapy in the treatment of favorable histology lymphomas. Prospective trials have not provided evidence to indicate that more intensive therapy will result in improved survival. In the unfavorable histology lymphomas such as diffuse histiocytic lymphoma and Burkitt's lymphoma, the results of combination chemotherapy are more dramatic and appear to have resulted in long‐term disease‐free survival. A significant fraction of these patients are probably cured as a result of this treatment. Effective regimens include the C‐MOPP Program and BACOP both of which have resulted in approximately 50% complete remission rate with 30 to 40% disease‐free long‐term control. The demonstration that high dose methotrexate with citrovorum factor rescue is capable of achieving responses in unfavorable histology lymphoma that is refractory to previous therapy has resulted in its inclusion with BACOP in the primary management of these patients. In addition, high dose methotrexate is capable of entering the cerebrospinal fluid in concentrations that are cytotoxic to tumor cells, thus providing a potential prophylaxis against central nervous system involvement as well as nonmarow suppressive therapy for systemic disease. Using this regimen, the complete remission rate is approximately 75% in patients with unfavorable histology lymphoma and at the present time only one out of 30 patients has relapsed in the central nervous system. Copyright © 1978 American Cancer Society