MANAGEMENT OF INTERMEDIATE-GRADE LYMPHOMAS

Intermediate-grade lymphomas are defined by the Working Formulation to include four histologic subgroups: follicular large-cell, diffuse sma ll-cleaved-cell, diffuse mixed small- and large-cell, and diffuse larg e cell (Groups D, E, F, and G, respectively). [1] These four histologi c subtypes were found to have ''intermediate'' median and overall surv ival features based on outcome analysis of 1,153 patients,vith non-Hod gkin's lymphomas. Clinicians, however, have come to ''expect'' differe nt criteria for intermediate-grade lymphomas. Those criteria include a n aggressive growth rate, a high risk of fatality early in the disease course without treatment, and a potential for cure using CHOP chemoth erapy (cyclophosphamide [Cytoxan, Neosar], doxorubicin [Adriamycin], v incristine [Oncovin], and prednisone). The expectations are summarized by overall survival graphs demonstrating an initial steep curve, foll owed by a discernible change in slope, and ending in a relatively flat fine or plateau representing the proportion of patients cured. [2] Th at is, an intermediate-grade lymphoma should be an aggressive disease that is potentially curable with CHOP. In that respect, the Working Fo rmulation is partly successful, but not by design.