A systematic overview of chemotherapy effects in indolent non-Hodgkin's lymphoma

A systematic review of chemotherapy trials in several tumour types was perf ormed by The Swedish Council of Technology Assessment in Health Care (SBU). The procedures For evaluation the scientific literature are described sepa rately (Acta Oncol 2001:40: 155-65). This synthesis of the literature on ch emotherapy For indolent non-Hodgkin's lymphoma (NHL), predominantly Follicu lar lymphoma, is based on 108 scientific reports including 31 randomised st udies, 38 prospective studies and 18 retrospective studies. These studies i nvolve 8 699 patients. The conclusions reached can be summarized into the f ollowing points: In initially localized disease The addition of chemotherapy to radiotherapy as primary treatment has not c onvincingly prolonged remission duration or survival. In initially advanced disease Alkylating agents are useful palliative treatment options which can result in improved well-being for most patients. often For long periods. Combinati ons of chemotherapy have not convincingly resulted in more or longer remiss ions. There is no proof that initial combination chemotherapy will prolong surviv al in comparison with single drugs. The addition of interferon to initial combination chemotherapy may increase the response rate. significantly prolong remission duration. but prolonged survival has not been unequivocally proven. In the absence of disease-related symptoms, treatment can safely be deferre d. For patients with relapsed lymphoma Patients may repeatedly respond to alkylating agents or combinations contai ning an alkylating agent, although the proportion responding decreases with each relapse. Patients relapsing after or who are refractory to treatment with alkylating agents often respond to treatment with combinations containing an anthracy cline. Responses are also often seen in patients treated with purine analog ues alone or in combination with other drugs. High dose chemotherapy followed by autologous or allogeneic reestablishment of bone marrow Function can induce long-term remissions but it is not prov en whether they are more Frequent or of longer duration than with conventio nally dosed therapy. The impact of the novel treatment strategies including high-dose therapy on overall survival is still uncertain. A monoclonal antibody, rituximab, is a new active substance for patients wi th relapsed lymphoma. It can induce remissions also in chemoresistant patie nts.