This review highlights the role of
chemotherapy for intermediate grade
non-Hodgkin's lymphoma (NHL) including
immunoblastic large cell lymphoma and low grade NHL. The combined modality treatment (CMT) consisting of
chemotherapy including
adriamycin (ADM) and involved-field irradiation (IFI) is considered standard
therapy for localized intermediate grade NHL since a superior outcome (long-term disease-free survival rate is about 80%) can be obtained by CMT. However, developing dose-intensified regimens in initial
chemotherapy will change the role of IFI. The phase II study using second and third generation regimens for advanced intermediate grade NHL showed a better outcome than first generation regimen CHOP. Unfortunately, the recent phase III intergroup trial concluded that none of the second or third generation treatment was superior to CHOP, and this regimen is now considered to be standard
chemotherapy. However, the cure rate of the
CHOP regimen (about 30%) is not satisfactory, and efforts should be underway to develop promising regimens with significantly increased dose intensity. While
radiotherapy such as IFI, extended-field irradiation and total lymph node irradiation for localized low grade NHL obtained a more than 50% disease-free survival rate, the role of
chemotherapy remains controversial. To date, many randomized trials of single agent
chemotherapy regimen,
combination chemotherapies with or without ADM, and CMT have shown no overall survival benefit for advanced low grade NHL, so there is no standard
therapy for it.