Non-Hodgkin's lymphoma (NHL) is the fifth most common malignancy in the United States, with 53,400 new cases and 23,400 deaths in 2003.1 The overall incidence of NHL rose by 80% over the past 3 decades, for reasons that are not entirely clear.2 3 Diffuse large B-cell lymphoma (DLBCL) is the most common histologic subtype of NHL. It accounts for almost one-third of cases and is considered the prototype for aggressive lymphomas.

DLBCL is a chemosensitive disease. Approximately half of the patients are cured with front-line anthracy-cline-based chemotherapy. However, many others will relapse after initial response and become candidates for potentially curative transplantation strategies. Patients with refractory disease, those who relapse following transplant and those who are not candidates for transplantation, have no true curative options and most will ultimately die of lymphoma. The factors determining clinical outcome are increasingly complex, and are discussed in detail below.

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