In the WHO classification of malignant lymphoma, aggressive lymphoma includes diffuse large B-cell lymphoma (DLBCL), mantle cell lymphoma (MCL), peripheral T-cell lymphoma, PTCL) non-specific or specific type, Anaplastic large cell lymphoma (ALCL), Follicular lymphoma grade III (FL3). Treatment of early-stage aggressive lymphoma Less than 20% of patients with DLBCL are truly limited. Except for clinical studies, the recommended treatment for limited-stage DLBCL is a short course of chemotherapy combined with Involved Field Radiotherapy (IFRT), or chemotherapy alone. The SWOG randomized study comparing 8 cycles of CHOP with chemotherapy alone or 3 cycles of CHOP with IFRT in patients with limited DLBCL showed that short courses of chemotherapy combined with IFRT were superior to chemotherapy alone, with better 5-year progression-free survival (PFS) and overall survival (OS) of 77%, respectively. (OS), 77% vs. 64% and 82% vs. 72%, respectively. Furthermore, the incidence of life-threatening toxicity and cardiotoxicity was significantly higher in the 8-cycle CHOP regimen chemotherapy alone group than in the short-course chemotherapy combined with IFRT group; patients over 60 years of age benefited more from short-course chemotherapy combined with IFRT. In another randomized study comparing the efficacy of an 8-cycle CHOP regimen with or without IFRT in patients with primary stage I with giant mass or extranodal involvement, and stage II diffuse large cell lymphoma, although 10-year OS ((68% vs 65%) was similar in both groups, disease-free survival (DFS) was better for patients who achieved complete remission (CR) with radiation therapy, 73% vs 56%. In the GELA LNH 93-1 trial, the high-intensity regimen ACVBP chemotherapy alone was more effective than CHOP regimen combined with IFRT in low-risk patients aged ≤60 years. These studies raise the question of the need for radiotherapy in early DLBCL. Similarly, there is a lack of information on the value of rituximab(R) for patients with early DLBCL in randomized phase III clinical studies. Treatment of advanced aggressive lymphoma If unable to participate in clinical studies, R-CHOP or CHOP regimens in combination with chemotherapy are currently recommended for advanced DLBCL or PTCL, regardless of whether the patient is older or younger than 60 years of age. The main issue in recent clinical studies has been the number of cycles of chemotherapy and the interval between cycles. In elderly DLBCL patients aged 60 to 80 years, the GELA study showed that R-CHOP was superior to CHOP regardless of PFS, DFS, and OS, and there was no difference in treatment-related toxicity. In the US subgroup study of a similar population, patients were first randomized to either the CHOP regimen or the R-CHOP regimen, and those who were effective were then randomized to the rituximab maintenance group and the observation group. The addition of R-CHOP chemotherapy with rituximab resulted in the same benefit in event-free survival (EFS) and OS, but the use of maintenance therapy did not improve outcomes in patients who had already received rituximab induction therapy. Similarly, in low- and intermediate-risk patients under 60 years of age (IPI score of 0 or 1), R-CHOP improved TTF (time to treatment failure) and OS over CHOP, with a greater benefit especially in patients with an IPI score of 1. The RICOVER-60 study looked at the number of cycles of chemotherapy in people younger than 60 years. The study compared the efficacy of adding rituximab to the CHOP-14 regimen with or without rituximab and with different numbers of chemotherapy cycles (6 or 8), with R- CHOP-14 being superior to CHOP-14 (6 or 8) and freedom from treatment failure (FFTF ) of 70% and 57%, but 8 cycles of R- CHOP-14 had no benefit over the 6-cycle R-CHOP-14 group. However, it remains unclear as to the superiority of 6- to 8-cycle R- CHOP compared with 6-cycle R-CHOP-14. For PTCL, similar treatment to DLBCL was used for either early or late stage patients. Stratified by IPI, patients with PTCL had worse DFS and OS than patients with DLBCL. There is no evidence to support the relative advantages between different treatment regimens for PTCL. ALCL is the T-cell lymphoma with the best prognosis, and ALK-positive ALCL has a very good prognosis with a 5-year OS of 79%. For patients with NK/T nasal T-cell lymphoma of IE/IIE, radiotherapy is the most important initial treatment, and the role of combination therapy remains controversial.