James O. Armitage, MD

In their new book entitled Current Therapy in Cancer, Drs. Foley, Vose, and Armitage endeavor to provide a short and concise presentation of various cancers. Their purpose is to aid clinicians in presenting a succinct overview of individual

Manifestations of mantle cell lymphoma were recognized in the 1970s as distinct from those associated with the more readily classifiable lymphomas. It was not until the 1990s, however, that observation of a combination of immunologic, cytogenetic, and molecular genetic abnormalities characteristic of this new malignancy confirmed its existence. The clinical and pathologic entity was named mantle cell lymphoma and in 1994 was incorporated into the Revised European American Lymphoma Classification. Mantle cell lymphoma is a CD5 positive, B-cell lymphoma that usually displays the t(11;14). The lymphoma has a striking male predominance and is widely disseminated at diagnosis in 80% of patients. Mantle cell lymphoma responds poorly to available therapies, and the median survival is approximately 3 years.[ONCOLOGY 12(Suppl 8):49-55, 1998]

The management of patients with the less aggressive subtypes of non-Hodgkin’s lymphoma remains a clinical challenge. As pointed out by Webster and Cella, this challenge relates, at least in part, to the comparatively long median survival that can be achieved in such patients with a wide variety of treatment approaches. However, it is very important to realize that not all patients with the indolent varieties of non-Hodgkin’s lymphoma are the same.

Gaynor and Fisher provide a literature review and analysis of the significance of dose intensity in determining treatment outcome in patients with intermediate-grade non-Hodgkin's lymphoma (NHL). Since most of the patients in the studies reviewed had diffuse large-cell lymphoma or its variants, that is the term that will be used in the remainder of this commentary. In their analysis, Gaynor and Fisher reach the conclusion that in the dose range tolerable without extraordinary supportive measures, increasing dose intensity has no demonstrable benefit.

Today, we can cure a significant portion of people with aggressive non-Hodgkin's lymphomas. The cure rate at 5 years for all patients with advanced diffuse large-cell lymphoma is approximately 35%.