Current trends in large cell lymphoma

Abstract

For the last decade, cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP) has been the best available standard of care for aggressive non-Hodgkin's lymphoma (NHL), based on equivalent therapeutic results with other multiagent chemotherapy accompanied by lower costs and lesser toxicity. However, only 40-45% of these patients are cured with CHOP. New treatment strategies have been employed, including the addition of Rituximab to CHOP in elderly patients; dose escalation using granulocyte-colony-stimulating factor; overcoming the multidrug resistance phenotype with infusional chemotherapeutic regimens and use of some newer agents. Furthermore, the International Prognostic Factor index (IPI) has permitted identification of subsets of patients with large variations in prognosis, allowing prognosis specific therapy to be tested. There is now accumulating evidence that the clinical behavior of certain NHL can be profiled by the expression of certain molecular markers, which will undoubtedly play a role in the development of new prognostic models that may refine our ability to identify poor-risk patients. Regardless, there is still significant opportunity for improving survival in large cell lymphomas.

CMC-544 (inotuzumab ozogamicin), an anti-CD22 immuno-conjugate of calicheamicin, alters the levels of target molecules of malignant B-cells

“…[1][2][3][4] Nevertheless, a considerable percentage of patients are refractory to treatment with rituximab and relapse after an initial response. Several resistant mechanisms have been proposed including escape into CD20-negative cells by limited surface antigen renewal, cell membrane drug efflux pumps, escape into the resting phase of the cell cycle, enhancement of complement inhibitory factors, alterations in intracellular signaling or cell death pathways, FcgRIIIA polymorphism and reduction of effector cells.…”

Prognostic Evaluation of Nodal Diffuse Large B Cell Lymphoma by Immunohistochemical Profiles with Emphasis on CD138 Expression as a Poor Prognostic Factor

“…Thus, we could easily and consistently evaluate the immunohistochemical staining results. The diversity in the clinical presentation, morphology, immunophenotype, and genetic and molecular alterations strongly suggests that DLBCL is a heterogenous group of B-cell lymphomas rather than a single clinicopathologic entity (12)(13)(14). The primary site of the lymphoma, either the lymph node or different extranodal territories, has been suggested as a criterion that might distinguish the two different groups of DLBCL, nodal and extranodal, with particular clinicobiological characteristics and different natural history (15,16).…”

Cellular and molecular signal transduction pathways modulated by rituximab (rituxan, anti-CD20 mAb) in non-Hodgkin's lymphoma: implications in chemosensitization and therapeutic intervention

“…Rituximab has been an important addition to the therapeutic armamentarium against low-grade FL (Hagenbeek et al, 2002;Cohen et al, 2003;Dillman, 2003), and furthermore, its utilization alone or combined with chemotherapy has been considered as firstline therapeutic option for patients with other types of hematological malignancies (Avivi et al, 2003), including B-CLL (Keating et al, 2002;Lin et al, 2003;Montserrat, 2003), mantle cell lymphoma (MCL) (Hiddemann et al, 2003), Waldenstrom's macroglobulinemia (WM) (Ghobrial et al, 2003), and aggressive DLBCL (Bieker et al, 2003;Blum and Bartlett, 2003;Coiffier, 2003;Fisher and Shah, 2003), providing significant opportunity for improving survival of these patients. Rituximab usage has also been extended to other pathologic states often culminating in long-lasting response.…”