HIGH-DOSE THERAPY FOR DIFFUSE LARGE-CELL LYMPHOMA IN FIRST REMISSION

Diffuse large-cell lymphoma (DLCL) is curable by first-line convention al chemotherapy in 50%-60% of patients. High- dose therapy makes no co ntribution to this group of patients and, if applied indiscriminately as first-line consolidation therapy, is likely to unnecessarily increa se overall morbidity and mortality. Instead, recent interest has been directed towards (a) the identification of a group of patients with a poor prognosis, and (b) the intensification of first-line treatment fo r such patients with high-dose therapy and allied regimens. Many progn ostic factors have now been standardised, while studies are progressin g in the identification of newer prognostic factors, such as the molec ular markers. Multi-centre randomised trials are currently in progress to determine the appropriate level of treatment for prognostic subset s, with the value of high-dose therapy being assessed for those in the worst prognostic groups.