High-dose therapy for diffuse large-cell lymphoma in first remission.

Diffuse large-cell lymphoma (DLCL) is curable by first-line conventional chemotherapy in 50%-60% of patients. High-dose therapy makes no contribution to this group of patients and, if applied indiscriminately as first-line consolidation therapy, is likely to unnecessarily increase overall morbidity and mortality. Instead, recent interest has been directed towards (a) the identification of a group of patients with a poor prognosis, and (b) the intensification of first-line treatment for such patients with high-dose therapy and allied regimens. Many prognostic factors have now been standardised, while studies are progressing in the identification of newer prognostic factors, such as the molecular markers. Multi-centre randomised trials are currently in progress to determine the appropriate level of treatment for prognostic subsets, with the value of high-dose therapy being assessed for those in the worst prognostic groups.