Lymphomas

Abstract

The majority of patients with early-stage (IA–IIA) Hodgkin's disease (HD) can at present be cured by current available therapeutic options. Actually the “gold standard” for patients with early-stage HD is a combined approach consisting of a short-duration chemotherapy (e.g., two to four cycles of doxorubicin, bleomycin, vinblastine, and dacarbazine; ABVD) and low-dose (20–30 Gy) involved-field irradiation (IF-RT). The treatment of choice for advanced-stage HD is still represented by chemotherapy alone or followed by RT. At present, it is internationally accepted that ABVD should be the standard regimen. High-dose chemotherapy (HDC) with peripheral-blood stem-cell support (PBSCs) represents the treatment of choice for patients relapsing after chemotherapy, but, nevertheless, about 50% of transplanted patients relapse or progress after HDC. Regarding low- and high-grade non-Hodgkin's lymphomas, Rituximab associated or not to chemotherapy, is much more extensively used. In advanced low-grade lymphomas the role of immunochemotherapy has been definitively demonstrated in a phase III study, comparing eight courses of rituximab plus chemotherapy (CVP regimen) versus CVP alone at diagnosis. Three courses of CHOP plus Rituximab associated to involved fields radiotherapy (RT) is considered to be the standard treatment in localized high-grade lymphoma. In advanced disease patients, intensified CHOP-like regimen and new therapeutic agents have been tried to improve the clinical results in newly diagnosed patients with encouraging results. Finally, several studies confirmed the usefulness of prognostic scores as IPI for high-grade lymphoma and FLIPI for follicular lymphoma, and the usefulness of PET in the staging of lymphomas.