摘要：

Looking back, the most important aspect of chemotherapy of lymphomas has not been the development of any individual treatment program, but rather the demonstration that chemotherapy could cure a significant fraction of patients with a common malignancy affecting a major organ system in adults. Although these treatments are cumbersome and complicated, one-half of all adults with lymphomas are now curable with treatment programs that involve combination chemotherapy alone or in conjunction with radiotherapy. However, the experimental method, so useful in the laboratory, has proved difficult to apply in clinical trials. Only after long years of analysis has it become apparent that controllable variables like dose intensity have not been carefully managed, and this failure may well account for the plateau effect in long-term survival noted in recent sequential studies of the chemotherapy of lymphomas. A requirement for publication of clinical trials in the future should be the provision of adequate data on total dose and dose rate for each drug used in the study to allow more accurate interpretation of dose intensity as a treatment variable. Furthermore, analysis of these data should provide new insight for the design of future clinical trials. Moving forward, we are faced with the interesting challenge of integrating new agents, some naturally occurring or genetically engineered biologics and other synthesized biochemicals that mimic sequences of protein or DNA, into existing clinical trials to accelerate their movement from bench to bedside. Considering the plethora of new ideas and new agents that require testing, physicians should be encouraged to become partners in this effort by considering all patients with lymphomas in the United States candidates for clinical trials.

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