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Outcomes of Non-Hodgkin’s lymphoma

What happens if the treatment is not successful? NHL is a disease that responds well to chemotherapy in general and so the medical profession is not willing to give up easily in this disease. In patients who relapse after standard first line therapy with standard chemotherapeutic agents, second line drug therapy with combinations of different agents is attempted and in younger and fitter individuals who show good evidence of remitting again, the achievement of a second remission may be followed by a high dose procedure and rescue, usually nowadays by autologous peripheral stem cells. This technique is only used in patients who show good chemoresponsiveness to standard second line chemotherapy and the high dose therapy and PBSC rescue is performed at the time of the achievement of second remission; a higher cure rate is thereby probably (final trial data still pending) achieved.

 

In low grade NHL, which as we have said above is a disease that tends to remit and relapse over many years, the efficacy of high dose therapy is a clinical trial subject that is ongoing. It is a subject that urgently needs to be clarified as the treating doctor currently does not know at what time to even consider this technique in a disease which, as we have said above, remits and relapses over many years; (at present the doctor does not know at what time to refer if at all, and whether delaying until the disease is more refractory to standard to conventional therapy prejudices the response to high dose therapy later).

 

Eventually, there comes a time in the natural history of some patients’ disease where the list of possible forms of curative therapies has run out and the prognosis for the patient is poor for survival. At this time, as for other forms of cancer, the strategy of the treating clinicians is switched to the patients’ symptoms and his/her general comfort in a disease that will ultimately kill the patient.


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