Dose-intensified treatment of diffuse large B-cell lymphomas

About 50% of all patients treated with CHOP (cyclophosphamide, doxorubicin, vincristine and prednisone) achieve complete remission, and about one third experience longterm disease-free survival and cure. Attempts to improve results by modifications of CHOP using escalated doses, additional drugs or the alternative use of putatively non-cross resistant chemotherapy regimens failed in randomised trials. With the availability of granulocyte colony stimulating factor (G-CSF) and the tool of autologous stem-cell support, dose escalation, dose densification (by interval reduction) or combinations thereofwere pursued to increase dose intensity. While dose escalation strategies including high-dose approaches necessitating stem cell support have not yet unequivocally been demonstrated to be superior to a baseline CHOP-21, dose dense (bi-weekly) modifications improved the outcome of young and elderly patients with aggressive lymphomas compared to baseline CHOP-21. Major goals in the rituximab era are the identification of the ideal chemotherapy partner for rituximab and the determination of the role of intensified rituximab within such approaches.