Guest editorial: Management of malignant lymphoma is continuously improving

Abstract

This issue of IJH contains four ‘‘Progress in Hematology(PIH)’’ review articles describing the management ofmalignant lymphoma, with a focus on recent clinical trials.Malignant lymphoma, characterized by its marked hetero-geneity, is the most frequent hematologic malignancy inthe world. Among the various subtypes of malignantlymphoma, the following three are clinically important:Hodgkin lymphoma, follicular lymphoma (FL), and diffuselarge B cell lymphoma (DLBCL). The current and futuremanagement of these three major subtypes are discussed byinternationally distinguished lymphoma experts who havecontributed to the establishment of the current standardmanagement of each subtype. In addition, the current andfuture management of NK/T cell lymphoma is discussed byDr. Yamaguchi, based on clinical trials recently publishedby her group.Current issues to be addressed in the management ofmalignant lymphoma differ somewhat from disease todisease. In Hodgkin lymphoma, continuous efforts toestablish more effective chemotherapy with or withoutradiotherapy have yielded high cure rates in patients withlocalized and advanced diseases. Drs. Eichenauer andEngert of the German Hodgkin Study Group (GHSG)prepared a comprehensive review article regarding thecurrent standard management, based mainly on clinicaltrials conducted by GHSG. Treatment strategies forHodgkin lymphoma are scientifically discussed, andupdated information, including that on ongoing clinicaltrials, should help readers to better understand the mostsuccessful history of using non-surgical treatment modali-ties in clinical oncology.In FL, which remains incurable in most patients, theissues are somewhat different from those in Hodgkinlymphoma. Anti-CD20 monoclonal antibodies, such asrituximab, and radioimmunotherapy have markedly pro-longed survival. In the second PIH article, Drs. Salles andGhesquie`res of Groupe d’Etudes des Lymphomes del’Adulte (GELA), which has recently been renamed theLymphoma Study Association (LYSA), summarize recentadvances in the management of patients with FL, based onthe results of recent clinical trials including the PRIMAStudy, which revealed the efficacy of maintenance use ofrituximab [1]. Considering the marked heterogeneity of FL,the prolonged median survival time probably exceeding15 years under the current treatment modalities, and theemergence of several less toxic but highly effective agents,personalized approaches will be more important in thetreatment of FL in the future.Since the establishment of rituximab plus CHOP as astandard therapy for DLBCL [2], progress has been lessremarkable. In the third PIH article in this issue,Drs. Roschewski, Dunleavy, and Wilson of the NationalCancer Institute in the United States present an excellentreview of further progress in the treatment of DLBCL. Animproved understanding of the biology of DLBCL hasrevealed a number of oncogenic driver mutations and sig-naling pathways essential for growth of the lymphoma cell.As many of these signaling pathways can be targeted bysmall molecule inhibitors, treatment of DLBCL may be instore for a paradigm shift.Finally, Dr. Yamaguchi in Japan summarizes newlydevelopedtreatmentstrategiesforNK/Tcelllymphoma,basedon the results of multicenter clinical trials. NK/T cell lym-phoma is a distinct disease subtype with dismal prognosis