Jane N. Winter, MD

This management guide covers the risk factors, screening, diagnosis, staging, and treatment of non-Hodgkin lymphoma.

The incidence rates of non-Hodgkin lymphoma (NHL) in the United States have almost doubled between 1970 and 1990, representing one of the largest increases of any cancer. Although the overall incidence rates of NHL began to stabilize in the late 1990s, the temporal trends varied by histologic subtype. Some of this increase may be artifactual, resulting from improved diagnostic techniques and access to medical care, or directly related to the development of NHL in 25- to 54-year-old men with human immunodeficiency virus (HIV) infection. However, additional factors must be responsible for this unexpected increase in frequency of NHL that has been observed throughout the United States.

Between 1950 and 1999, the incidence of non-Hodgkin's lymphoma (NHL)rose by 90% in the United States, representing one of the largest increases ofany cancer. Some of this increase may be artifactual, resulting from improveddiagnostic techniques and access to medical care, or directly related to thedevelopment of NHL in 25- to 54-year-old men with human immunodeficiencyvirus (HIV) infection. However, additional factors must be responsiblefor this unexpected increase in frequency of NHL that has been observedthroughout the United States.

High-dose therapy with hematopoietic progenitor-cell transplantation plays a key role in the treatment of Hodgkin’s disease and the non-Hodgkin’s lymphomas. First and foremost, transplantation is used as a salvage treatment for those who relapse or do not achieve a complete remission with first-line chemotherapy. Carefully selected patients with poor prognostic features may benefit from the incorporation of high-dose therapy and transplant into their initial treatment programs. Despite a myriad of trials, many pivotal questions regarding the appropriate application of high-dose therapy with transplantation to the lymphoid malignancies remain unsettled, including the role of allogeneic transplantation and the optimal timing of transplant for patients with poor prognostic indicators. Phase III studies are required to address these issues; these trials will demand the active commitment of concerned transplanters and referring hematologists and oncologists. Although autologous transplantation has been the preferred approach for the majority of patient subgroups, new approaches to allogeneic transplantation that have diminished toxicity may pave the way for a greater role for allogeneic grafting in the lymphoid diseases. [ONCOLOGY 13(12):1635-1645, 1999]