Management of intermediate-grade lymphomas

Intermediate-grade lymphomas are defined by the Working Formulation to include four histologic subgroups: follicular large-cell, diffuse small- cleaved-cell, diffuse mixed small- and large-cell, and diffuse large cell (Groups D, E, F, and G, respectively). [1] These four histologic subtypes were found to have 'intermediate' median and overall survival features based on outcome analysis of 1,153 patients with non-Hodgkin's lymphomas. Clinicians, however, have come to 'expect' different criteria for intermediate-grade lymphomas. Those criteria include an aggressive growth rate, a high risk of fatality early in the disease course without treatment, and a potential for cure using CHOP chemotherapy (cyclophosphamide [Cytoxan, Neosar], doxorubicin [Adriamycin], vincristine [Oncovin], and prednisone). The expectations are summarized by overall survival graphs demonstrating an initial steep curve, followed by a discernible change in slope, and ending in a relatively flat line or plateau representing the proportion of patients cured. [2] That is, an intermediate-grade lymphoma should be an aggressive disease that is potentially curable with CHOP. In that respect, the Working Formulation is partly successful, but not by design.