Clinical issue: Malignant lymphomas are the most common cancers of the hematopoietic system.
Standard treatment: The treatment is usually cytotoxic chemotherapy after the appearance of symptoms in indolent lymphoma and immediately in aggressive lymphoma. Local therapy, such as radiotherapy is sometimes required in addition to systemic treatment.
Treatment innovations: By the introduction of targeted therapies the prognosis has improved. The monoclonal antilymphoma antibody rituximab is a prototype for many other cancers.
Diagnostic work-up: A biopsy is mandatory for diagnosis. Additional immunohistological and molecular genetic analyses may provide prognostic information. Imaging techniques, such as computed tomography (CT), ultrasound or positron emission tomography (PET) are used for staging, restaging and follow-up. Following chemotherapy for Hodgkin's disease PET can be considered to identify patients who do not require additional radiotherapy.
Performance: Aggressive lymphomas are often curable. In Hodgkin's disease the long-term survival rate is over 90% and in diffuse large cell lymphoma between 60-90%. Indolent lymphomas are not curable by standard therapy, however, the survival rate is also high.
Achievements: After introduction of rituximab, the survival chance has improved by at least 10% in both indolent and aggressive lymphomas. Other targeted therapies and autologous or allogeneic transplantation have made additional contributions.
Practical recommendations: Due to the rapid increase of knowledge patients should be treated in experienced centers and whenever possible, in clinical trials. Using molecular genetic analyses and functional imaging, the treatment can be individualized even more.