Advances in the treatment of aggessive lymphomas. Part 3 of a 3-part series: Advances in the treatment of hematologic maliganancies

Despite recent declines in overall cancer mortality rates in the United State, the incidence and mortality rates for lymphoma has been increasing. For patients with high-risk diffuse large B-cell lymphoma, treatment options currently being explored include various combinations of the monoclonal antibody rituximab plus chemotherapy, as well as high-dose and dose-dense chemotherapy followed by transplantation. For mantle cell lymphoma, researchers are evaluating bortezomib, tositumomab plus iodine tositumomab, the cyclin D1 regulator temsirolimus, and allogeneic stem cell transplantation. Because mantle cell lymphoma is often chemotherapy-sensitive, many clinical trails have focused on determining the optimal treatment strategy following an initial response with chemotherapy. Strategies being investigated for these patients include autologous stem cell transplantation and interferon-α treatment. For the treatment of mature T-cell lymphomas, a standard-of-treatment has not been established and progress has been hampered by a lack of randomized clinical trials. However, several treatments are currently being evaluated, including primary allogeneic transplantation, alternative chemotherapy regimens, and alemtuzumab. In the area of immunodeficiency-associated lymphosproliferative disorders, a number of recent studies have focused on human immunodeficiency virus-related non-Hodgkin lymphoma. Outcomes for these patients have improved significantly with the introduction of highly active antiretroviral therapy. Finally, (or posttransplantation lymphoproliferative disorders, minimizing immunosuppression has been a hallmark of treatment strategies, and rituximab has demonstrated activity in these patients.