Advances in the treatment of non-Hodgkin's lymphoma.

The use of more aggressive multiagent combination chemotherapy for the treatment of advanced diffuse aggressive lymphomas has resulted in a dramatic change in the overall outlook in patients with this disease. Once rarely curable or even controllable, it is now one of the most curable of disseminated malignancies. Sustained, disease-free survival rates have risen from 5% in the 1960s to approximately 65% in the 1980s. The 35% who do not achieve initial CR generally experience a fulminant course, with patients rarely surviving more than 2 years. Subsequent clinical trials will explore a number of new approaches including short-course, dose-intense induction regimens, addition of new agents into combinations (including cisplatin, vindesine, M-AMSA, ifosfamide, and methyl-GAG), and the use of biologicals (monoclonal antibodies, interleukin-2 plus LAK cells, and tumor necrosis factor). Salvage therapy for those who experience recurrence of disease can produce responses in 45 to 65% of patients, but remission duration is short, and median survival time is usually less than 1 year. Recent interest in high-dose chemotherapy with or without total body irradiation, followed by autologous bone marrow transplantation for relapsed patients, has produced some encouraging results.