Bertrand Coiffier, MD, PhD

Elderly patients may have several such comorbidities, but their impact on normal life is minimal-and so most of these patients may receive a curative treatment such as R-CHOP. Very elderly patients have more comorbidities with greater impact, with the result that some of their vital organs exhibit functional deficiency.

In this article, we review the current knowledge on the biological findings, clinical features, and therapeutic approaches for splenic marginal zone lymphoma.

The aim of this review is twofold: to summarize descriptions of the clinical presentation provided in published series in order to help clinicians recognize and treat patients, and to discuss diagnostic difficulties faced by hematopathologists when dealing with these lesions and others in the differential diagnosis that must be distinguished from one another.

Marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) lymphoma is an indolent B-cell non-Hodgkin lymphoma arising from the lymphoid tissue at extranodal sites.

Jacobson and LaCasce have provided a thorough review of post-transplant lymphoproliferative disorders (PTLDs), but the authors did not completely cover the field. While the article describes the development of lymphoid tumors related to Epstein-Barr virus (EBV) in patients who have received an organ transplant, it did not consider PTLDs developing after hematopoietic stem cell transplant, a condition also related to EBV but which is more aggressive. Not all PTLD cases are related to EBV, however, and as in patients with HIV (human immunodeficiency virus) infection or hereditary immune deficiency, other lymphoma subtypes may be observed, including T-cell lymphomas[1] (anaplastic large cell lymphoma,[2,3] hepatosplenic lymphoma[4]), indolent lymphomas[5]; and also Hodgkin lymphoma,[6,7] multiple myeloma,[8] or lymphoproliferative disorders associated with human herpes virus 8 infection.[9]

As the authors have correctly pointed out, Hodgkin lymphoma (HL) in elderly patients is an orphan disease that has been the subject of very few specific studies, particularly regarding treatment.

Recent trials have demonstrated improvements in progression-free and overall survival with the inclusion of the chimeric anti-CD20 monoclonal antibody rituximab (Rituxan) in chemotherapy regimens for treatment-naive and relapsed patients with advanced-stage follicular non-Hodgkin's lymphoma (NHL). As rituximab therapy has significant single-agent activity in follicular NHL, is generally well tolerated, and has no dose-limiting or significant hematologic toxicity, a number of approaches evaluating maintenance therapy with extended dosing of rituximab are being tested. Trials have demonstrated prolonged progression-free survival in patients treated with maintenance rituximab using a variety of schedules following treatment with single-agent rituximab, induction or salvage chemotherapy, or salvage therapy with rituximab and chemotherapy combinations. Small increases in neutropenia and infections have been reported with extended rituximab use. Ongoing trials are evaluating the optimal use of rituximab (maintenance vs retreatment) and the benefit of rituximab maintenance following treatment of therapy-naive patients treated with rituximab-containing chemoimmunotherapy induction regimens. This article discusses the risks and benefits of maintenance rituximab for follicular NHL.

The Groupe d’Etude des Lymphomes de l’Adulte (GELA) has conductedseveral phase II and III studies in patients with aggressive lymphoma,diffuse large B-cell lymphoma (DLBCL), and T-cell lymphomasduring the past 20 years, in France and Belgium. These studieshave demonstrated that the outcome of patients with DLBCL may beimproved and that the standard CHOP (cyclophosphamide, doxorubicinHCl, vincristine [Oncovin], prednisone) regimen is not sufficient tocure a large number of patients. The first improvement was the demonstrationof superiority of a dose-dense and dose-intense regimen, ACVBP(doxorubicin [Adriamycin], cyclophosphamide, vindesine, bleomycin,prednisone). The second improvement was made in young patients withpoor-risk lymphoma by intensifying their treatment with high-dosetherapy and autotransplant. The third and most significant improvementwas in the results associated with the combination of rituximab(Rituxan) and chemotherapy. Current studies look at decreasing thenumber of patients truly refractory to chemotherapy, decreasing relapserate with rituximab maintenance, and finding an appropriate regimenfor patients with T-cell lymphoma.

At the 2000 Annual Meeting of the American Society of Hematology, we presented the benefits of rituximab (Rituxan) combined with CHOP (cyclophosphamide [Cytoxan, Neosar], doxorubicin HCl, vincristine [Oncovin], prednisone), known as R-CHOP, in comparison with CHOP alone for the treatment of elderly patients with diffuse large B-cell lymphoma (DLCL).

Records from 653 patients treated between 1991 and 1998 in the Oncology Practice Patterns Study (OPPS) were analyzed to determine contemporary chemotherapy delivery patterns in patients with intermediate-grade non-

Drs. Haase-Statz and Smalley review the role of interferon-alfa (Intron A, Roferon-A) in the treatment of lymphomas. As they point out in the introduction to their article, lymphoma is a very heterogeneous disease with more than 10 different entities and