ABSTRACT
Lymphomas represent the fifth most common malignancy in the western world in
incidence, accounting for approximately 5% of new cancer diagnoses amounting
to approximately 60,000 new diagnoses each year in the United States (1).
Patients with this group of disorders typically present with symptoms related
to lymphadenopathy, as well as constitutional symptoms such as fevers, night
sweats, or weight loss. Diagnosis is ideally made by excisional biopsy of an
involved lymph node. This is followed by the standard initial evaluation that
includes staging by physical examination, computerized tomography and bone
marrow studies to determine the extent of the disease, as these factors are import-
ant in determining the most appropriate therapy. The other major factor that influ-
ences the chosen therapy is the histological subtype. In general, patients with
Hodgkin’s disease are treated with curative intent. In contrast, patients with
non-Hodgkin’s lymphoma can be divided into two broad groups. The first
group is the group of patients with “aggressive” histology with the prototypic
subtype being diffuse large B-cell lymphoma, the most common non-Hodgkin’s
lymphoma (NHL) (2). Patients with aggressive histologies are also treated with
curative intent, typically with combination chemotherapy for patients with
advanced stage disease, and with short-course combination chemotherapy fol-
lowed by involved field radiation therapy for patients with early-stage disease.
With this approach, approximately 30% to 60% of patients can achieve long-
term remissions (3). Unfortunately, the majority of patients with aggressive
lymphomas will not be cured by primary therapy. For these patients, high-dose
chemotherapy with hematopoietic stem cell transplantation has been shown to
improve outcomes compared with further standard chemotherapy, though only
30% to 50% of such patients with responsive disease have the possibility of
long-term remission with this approach (4). For such patients who have relapse
following a hematopoietic stem cell transplant, the options for prolonged
disease-free survival are limited to investigational therapies.
