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Philip J. Bierman, MD

Philip J. Bierman, MD

University of Nebraska Medical Center, Omaha, Nebraska

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Radiation therapy has an essential role for certain patients with DLBCL. It is hoped that ongoing and future trials will identify the patients who will benefit from this treatment and those for whom it is unnecessary.

Burkitt lymphoma (BL) is a unique B-cell lymphoma characterized by a high proliferation rate and cytogenetic changes related to c-myc proto-oncogene overexpression. Burkitt lymphoma is a highly aggressive B-cell lymphoma that is most frequently seen in children and young adults in endemic areas.

The past 20 years have brought significant advances in our ability to manage patients with non-Hodgkin's lymphoma. More precise classification systems, improvements in diagnosis and staging, and effective new treatments have improved outcomes and made cure a reasonable goal for many patients with these disorders.

The most common indolent lymphoma, follicular lymphoma comprises
35% of adult non-Hodgkin’s lymphoma (NHL) in the United
States and 22% worldwide. Features associated with adverse outcome
include age, male gender, disease stage, and performance status, with
the International Prognostic Index being the most widely used risk classification
system. Long-term disease-free survival is possible in select
patient subgroups after treatment, but very late relapses suggest that
quiescent lymphoma cells might be harbored for long periods of time.
Radiation therapy is the mainstay of treatment for limited-stage follicular
lymphoma, but there is some experience with chemotherapy and
combined chemoradiation. When to initiate treatment in patients with
advanced disease is controversial, but options include various combined
chemotherapy regimens, monoclonal antibodies, radiolabeled antibodies,
and bone marrow or stem cell transplantation. Future directions in
the treatment of follicular lymphoma include vaccines, antisense
therapy, and proteasome inhibitors.

The analysis, “Graft Purging in
Autologous Bone Marrow
Transplantation: A Promise Not
Quite Fulfilled,” by Drs. Joseph Alvarnas
and Stephen Forman, is very
timely. The authors’ conclusion is succinctly
presented in their title.

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-

Randomized trials are defining the role of autologous stem-cell transplantation in aggressive non-Hodgkin’s lymphoma (NHL), but there is less experience with this treatment in follicular lymphomas. Approximately 40% to 50% of patients with follicular NHL are in remission 4 to 5 years following autologous stem-cell transplantation. Results from phase II studies and retrospective analyses are remarkably similar, despite differences in patient populations, preparative regimens, use of purging, and source of stem cells. Nevertheless, there is little evidence of a plateau in disease-free survival curves, and we do not know whether patients are cured or overall survival is prolonged. Relapses 9 years following transplantation have been described.[1]

Autologous hematopoietic stem- cell transplantation has become an accepted therapy for some patients with Hodgkin’s disease and non-Hodgkin’s lymphoma. Convincing evidence for a graft-vs-lymphoma effect has led to increasing use of allogeneic transplantation in these patients. Dr. Winter has written an excellent overview of transplantation in the lymphomas. She has focused on several areas of controversy and described results of randomized trials.

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