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been examined in randomised trials. Improved DFS (and overall survival in one of three studies) was demonstrated for patients with >2 adverse factors on IPI. Further studies are in progress. It seems likely that a group of poor prognosis patients may benefit from intensive consolidation and the option should be discussed with eligible high risk patients in first remission.

Monoclonal antibody therapy: rituximab produces responses in ~30% relapsed DLBCL. More promising role in combination with initial chemotherapy: addition of Rituximab to CHOP initial therapy improved the CR rate (76% vs. 63%) and EFS (57% vs. 38%) and overall survival (70% vs. 57%) at 2 years with no added toxicity in a randomised study of 204 400 elderly patients with DLBCL2. Confirms Phase II data and further Phase III studies in progress has been endorsed by NICE5 R-CHOP for use as first line therapy for DLBCL.

Tositusimab:under examination in combination with BEAM high dose therapy to enhance tumour cell kill in autologous SCT for aggressive lymphoma.

Mantle cell lymphoma: CHOP produces response rate ~80% (CR ~50%) with PFS <18 months and overall survival of 3 years and is not markedly different from results obtained with CVP. Regimens such as fludarabine and cyclophosphamide can achieve further responses. Rituximab alone achieves response rate ~35% (14% CR) with a median duration <1 year. Combination of rituximab with CHOP achieved a high rate of 'molecular remissions' as initial therapy but a disappointing median PFS of 16 months. The combination of rituximab with several salvage regimens (e.g. FCM) improves responses. Relapsed patients with MCL who respond to salvage therapy achieve further remissions with high dose therapy and autologous SCT but further relapse is usual. Rituximab pre-harvest acts as in vivo purge increasing the proportion of PCR -ve collections. High dose therapy and ASCT in first remission prolongs response duration and probably survival but is probably not curative . Suitable patients with a sibling allogeneic SCT option should receive an allograft.

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