Autologous stem cell transplantation for non-Hodgkin’s lymphoma – pro
Lay Summary: Autologous stem cell transplantation is standard for relapsed non-Hodgkin’s lymphoma.
Patients with aggressive and intermediate non-Hodgkin’s lymphoma (NHL) treated at first diagnosis with polychemotherapy alone or combined chemoradiotherapy can achieve high response rates . However, patients with relapsed or progressive disease still have a poor prognosis. High-dose chemotherapy (HDCT) followed by autologous stem cell transplantation (ASCT) is the treatment of choice for these patients. The most compelling evidence for the superiority of HDCT compared with conventional-dose salvage therapy in relapsed and progressive NHL is based on the randomized ‘Parma trial. In this study, all patients received two cycles of conventional chemotherapy. The responders were randomized to receive either four cycles of conventional chemotherapy or HDCT (BEAM) followed by autologous stem cell transplantation (ASCT). The response rate was 44% in the group with conventional chemotherapy and 84% in the HDCT group. The analysis at 5 years revealed that patients treated with HDCT had superior outcome as measured by freedom from second failure (FF2F) (12% versus 46%) and by overall survival (OS, 32% and 53%). Therefore, two cycles of conventional salvage chemotherapy followed by HDCT and PBSCT is considered standard treatment for these patients. However, in the ‘Parma trial’ more than 50% of patients treated in the HDCT-arm relapsed and most of them died. New approached to improve these results are ongling; however, autologous stem cell transplantation for relapsed non-Hodgkin’s lymphoma is currently standard and NCCN recommended. On p. BCEL-6, NCCN recommends allogeneic transplant in selected cases, which it defiens as mobilization failure or persistent bone marrow involvement. The strategy of combining autologous and subsequent allogeneic transplant is experimental.
A. Josting et al, High-dose sequential chemotherapy followed by autologous stem cell transplantation in relapsed and refractory aggressive non-Hodgkin’s lymphoma: results of a multicenter phase II study Annals of Oncology 2005 16(8):1359-1365
H. Tilly1 et al, Diffuse large B-cell non-Hodgkin’s lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up Ann Oncol (2010) 21 (suppl 5): v172-v174.
American Society for Blood and Marrow Transplantation. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of diffuse large B cell lymphoma: update of the 2001 evidence-based review. Biol Blood Marrow Transplant 2011 Jan;17(1):18-9.
nccn.org, 2012
Revised July 10, 2011