Systemic therapy of lymphoma

Lymphoproliferative disorders are disseminated in nature and hence therapy for the lymphoid malignancies has shown an increasing shift away from local therapy and toward systemic therapy. For a long time, cytotoxic chemotherapy has been the mainstay of systemic therapy for the lymphoid malignancies, but increasing knowledge about the basic molecular biology of these illnesses has resulted in the increasing use of agents targeted against key metabolic pathways responsible for carcinogenesis. In this chapter we will discuss the basic principles of action of the various individual chemotherapeutic agents, the rationale of combining two or more individual agents together, the concepts of high-dose chemotherapy with stem cell support, the newer targeted agents including monoclonal antibodies and small molecules that affect key intracellular pathways, and finally look at agents that are currently being investigated.