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Prognostic factors in the non-Hodgkin's lymphomas--a time for consensus?

British Journal of Cancer
Nature Publishing Group
Publication Date
  • Research Article
  • Biology
  • Medicine


Br. J. Cancer (1991), 63, 837 840 © Macmillan Press Ltd., GUEST EDITORIAL Prognostic factors in the non-Hodgkin's lymphomas a time for consensus? J.A. Child The General Infirmary at Leeds, Leeds, UK. The lymphoproliferative disorders continue to be the subject of intensive and rewarding investigation. At a cellular level much has been learned about their characteristics. Yet, two decades since the introduction of combination chemotherapy for the treatment of the more aggressive categories, there is confusion and controversy as to whether the more recently evolved intensive therapeutic approaches represent any ad- vance at all. It is the very heterogeneity of these diseases at a cellular level which largely explains the difficulty nowhere are the potential fallacies of comparing the treatment of patients by different groups and centres greater than in the diverse malignancies which we group together as non-Hodg- kin's lymphomas (NHL). While large randomised trials such as those currently com- paring second and third generation chemotherapy with simp- ler cyclical combinations in intermediate and high grade lymphomas are certainly overdue, we should not look to them to provide all the answers in terms of the way ahead. There is a growing realisation that a more selective approach in treatment is now desirable the prime example being the delineation of patients for whom intensive treatment includ- ing allogeneic or autologous bone marrow transplantation is appropriate. There is now a wealth of data on prognostic factors to form the basis of more critical comparisons of the results of treatment between groups of investigators. It should also prove possible to define, prospectively, subsets for which different therapeutic approaches are needed. Histopathological classification and pathological variables Although discrete diagnostic entities have been described, the fact that the proliferations at a cellular level represent what may be considered as a discontinuous spectrum of disorders has

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