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The treatment options for intermediate-grade and high-grade lymphomas, which tend to be more aggressive, are much more straightforward than those for the low-grade (indolent) lymphomas. Combination chemotherapy with CHOP (cyclophosphamide/doxorubicin/vincristine/prednisone) is considered as standard treatment for intermediate-grade and high-grade lymphomas.

For patients with early stage disease (Stage I or II), CHOP chemotherapy is usually followed by localized external-beam radiation therapy. Although CHOP is the standard regimen, your cancer specialist may elect to use a different combination of anticancer drugs in place of CHOP especially if your type of lymphoma is considered to be very aggressive. Examples of these chemotherapeutic regimens include:

• m-BACOD - bleomycin/doxorubicin/cyclosphosphamide/vincristine/dexamethasone/ methotrexate/leucovorin
• ProMACE - prednisone/methotrexate/leucovorin/doxorubicin/cyclophosphamide /etoposide
• CytaBOM- cytarabine/bleomycin/vincristine/methotrexate

Despite the availability of these newer chemotherapeutic regimens, research has shown no benefits in terms of either efficacy (cure rate) or survival between these newer agents and CHOP. However, because these newer regimens are more toxic (cause more side-effects) and are more costly, CHOP remains the standard regimen of choice in most cases. CHOP is also considered the standard chemotherapeutic regimen for patients with intermediate-grade or high-grade lymphomas with more advanced disease (Stage III or IV). In patients over the age of 60, CHOP chemotherapy may be combined with immunotherapy using a monoclonal antibody such as rituximab (Rituxan).

Currently, the standard of care for the treatment of intermediate-grade (diffuse large B cell) lymphoma is rituximab combined with CHOP or a similar regimen such as those listed above. Patients receiving rituximab as part of their regimen have higher survival and remission rates than those not receiving rituximab. Also, some physicians now administer CHOP chemotherapy every 2-weeks instead of the usual (standard) every 3-weeks dosing schedule. This is termed "dose defense" chemotherapy and may be more effective for elderly patients with intermediate-grade non-Hodgkin's lymphoma. A myeloid growth factor called pegfilgrastim (Neulasta) must be given when using the shorter 14-day chemotherapy cycle. Otherwise, the white blood cells would not recover sufficiently between chemotherapy cycles to enable the use of the shorter-interval dosing schedule.