Chemotherapy for Hodgkin's disease and aggressive non-Hodgkin's lymphoma. More is better, or is it?

The development of combination chemotherapy regimens for the treatment of advanced Hodgkin's disease and aggressive non-Hodgkin's lymphoma are historical landmarks in oncology. Over 70% of patients with advanced Hodgkig's disease will be cured following administration of MOPP [chlormethine (mustine), vincristine, procarbazine and prednisolone] or MOPP-derived regimens (Henry-Amar & Somers 1990); and, whereas chemotherapy with cyclophosphamide, doxorubicin (adriamycin), vincristine and prednisolone (CHOP) is less successful in the therapy of advanced intermediate and high grade non-Hodgkin's lymphoma, with complete remission (CR) rates of 60 to 85% and prolonged survival in around 30% of patients, the advent of such therapy still represented a dramatic advance. These combination cytotoxic regimens, with certain adaptations, have now become established as standard treatment for these diseases, but further progress has been slow. Oncologists have attempted to develop and refine more effective and less toxic therapies for patients at first presentation, and also at relapse, by a number of means.