Hematopoietic stem cell transplantation in non-Hodgkin lymphoma

Davies, Andrew J. and Gribben, John G. (2005) Hematopoietic stem cell transplantation in non-Hodgkin lymphoma. Current Opinion In Organ Transplantation, 10 (1), 35-39. (doi:10.1097/01.mot.0000152690.24829.ca).

Abstract

Purpose of review: Although high-dose therapy with stem cell transplantation (SCT) has become standard of care in patients with chemotherapy-sensitive relapse of 'aggressive' non-Hodgkin lymphoma (NHL), its role both at the time of disease presentation and in other histologic subtypes of NHL remains controversial. Emerging data on allogeneic transplantation have also led to renewed interest in NHL. We review recent literature in this field.

Recent findings: In 'aggressive' lymphoma, a randomized study has demonstrated the superiority of an intensive regimen over conventional CHOP (cyclophosphamide, doxorubicin, vincristine and prednisolone in patients with high-intermediate International Prognostic Index scores. Similarly, at recurrence of follicular lymphoma, high-dose therapy and SCT provide an advantage in progression-free and overall survival over conventional chemotherapy but demonstrated no benefit from ex-vivo purging. Data continue to mount supporting a role for allogeneic transplantation with reduced-intensity conditioning regimens and furthermore a graft-versus-lymphoma effect in some clinical settings in NHL.

Summary: The role of both autologous and allogeneic SCT in NHL continues to evolve. Randomized trials are helping define the place for such strategies; however, because of the relative rarity of some histologic subtypes, such studies may not be feasible. The maturation of well-conducted phase II studies and registry data are pivotal to guiding us under these circumstances.

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Contributors

Author: Andrew J. Davies

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