TREATMENT OF ADULT INTERMEDIATE GRADE NON -HODGKINS-LYMPHOMA

In the past 20 years increasing incidence 15/100,000 of non Hodgkin's lymphoma (NHL) has been observed. Despite their heterogeneity intermed iate grade NHL are potentially cured with chemotherapy. Advances in ou r understanding of the biology and in their treatment have been made. Factors, such as age, stage, performance status, and predicting treatm ent outcome are useful parameters to decide on the intensity of chemot herapy. With conventional treatment, 80% of the patients without adver se prognostic factors can be cured. For patients with at least two adv erse factors only 40% are long term survivors. Different dose-escalati on chemotherapy regimens has been rested including autologous hematopo ietic stem cell transplantation (ASCT). At tile present lime, no clear improvement has been seen in randomized trial when intensification is made after obtention of complete remission. However, for relapsing pa tients ASCT can provide 46% disease free survival in patients still se nsitive to salvage chemotherapy and ASCT is the therapy of choice unde r 60 years old. New development of technology with mobilized periphera l stem cell (PBPC) allowed to develop early intensive treatment with a cceptable toxicity. Encouraging results hare been reported and tested in randomized trial in patients less than 60 years old. Improvement of tile treatment of older patients remains problematic considering that chemotherapy cart increase hematopoietic and nonhematopoietic lethal complications reducing the chance to achieve complete remission.