Non-Hodgkin's lymphoma: Role of high-dose therapy in diffuse large B-cell lymphoma

Abstract

Diffuse large B-cell lymphoma is the most frequent Non Hodgkin's Lymphoma entity seen in the westera world, over 30% of all cases. Furthermore, the disease incidence is increasing in most western countries. Although it is a curable disease most patients will eventually die due to disease accounting for relapse. Despite many attempts during the last three decades to increase the cure rate of 35 to 40%, we have not yet succeeded in improving the results significantly since CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone) chemotherapy was introduced in the 1970s [1]. Second and third generation regimens as compared to the first generation CHOP failed to demonstrate an advantage over the CHOP regimen [2,3]. More recently, attempts to improve treatment outcome have focused on increasing the dose intensity of cytotoxic drugs by applying high-dose chemotherapy, with or without involved field or total body irradiation, supported by autologous haematopoietic stem cell transplantation. Autologous bone marrow and, more recently, autologous haematopoietic stem cells collected from peripheral blood after mobilisation from bone marrow have both been used to assure haematopoietic reconstitution after high-dose myeloablative chemotherapy. The availability of haematopoietic growth factors has facilitated both the mobilisation of haematopoietic stem cells into the peripheral blood and the application of high-dose chemotherapy programs [4-8]. Furthermore efficient purging procedures of stem cells before reinfusion is an other important step towards improving treatment results. Important clinical and biological prognostic factors as well as molecular therapeutic targets have been identified and are instrumental in further improving our treatment strategy. High-dose chemotherapy with autologous stem cell support in relapsed patients