Cancer Treatment Today

Diffuse large-cell lymphoma is the most common form of NHL, and autologous stem cell transplantation has been shown to be beneficial in some subsets with this illness. For patients with diffuse large-cell lymphoma who relapse from a CR but remain chemotherapy-responsive, autologous transplantation is the treatment of choice. At the present time, high-risk patients who achieve a CR after a full course of standard-dose chemotherapy and have a high risk for relapse may derive the most benefit from stem cell transplantation.

For anaplastic lymphoma specifically, a phase II trial that used high-dose chemotherapy and autologous stem cell transplantation (ASCT) as front-line treatment revealed a 5-year overall survival rate of 87%, which was significantly better than for aggressive nonanaplastic lymphomas. To date, no published randomized trials compare ASCT to conventional combination chemotherapy regimens. NCCN has no recommendations for anaplastic or ALK negative lymphoma. ALK negative lymphomas have a poorer prognosis than ALK positive ones.

A 2011 reveiw by Hosing says: ” For patients with relapsed and/or refractory disease and for those who relapse after ASCT, allogeneic transplantation should be considered if a human leukocyte antigen-compatible related or unrelated donor is available and they have a good performance status. In some heavily treated patients, reduced-intensity conditioning may provide a graft-versus-lymphoma effect with acceptable NRM. No recommendations can be made regarding alternative donor transplants due to the paucity of data. However, alternative donor transplant could be considered as part of a clinical trial. There are not enough data to recommend reduced-intensity versus myeloablative conditioning regimens, but the higher rate of relapse noted after reduced-intensity conditioning regimen is a concern. Studies of allogeneic transplantation as part of frontline therapy in patients with T-cell lymphoma who present with aggressive disease are under way.”

H. Bertz, R. Zeiser, W. Lange, S. Fetscher, C. F. Waller, and J. Finke
Long-term follow-up after high-dose chemotherapy and autologous stem-cell transplantation for high-grade B-cell lymphoma suggests an improved outcome for high-risk patients with respect to the age-adjusted International Prognostic Index
Ann. Onc., September 1, 2004; 15(9): 1419 – 1424.

M. D. Caballero, J. A. Perez-Simon, A. Iriondo, J. J. Lahuerta, J. Sierra, J. Marin, M. Gandarillas, R. Arranz, J. Zuazu, V. Rubio, A. Fernandez de Sevilla, E. Carreras, J. Garcia-Conde, J. Garcia-Larana, C. Grande, A. Sureda, M. J. Vidal, J. Rifon, C. Perez-Equiza, R. Varela, J. M. Moraleda, J. C. Garcia Ruiz, C. Albo, R. Cabrera, J. F. San Miguel, and E. Conde
High-dose therapy in diffuse large cell lymphoma: results and prognostic factors in 452 patients from the GEL-TAMO Spanish Cooperative Group
Ann. Onc., January 1, 2003; 14(1): 140 – 151.

Deconinck E, Lamy T, Foussard C, et al. Autologous stem cell transplantation for anaplastic large-cell lymphomas: results of a prospective trial. Br J Haematol. Jun 2000;109(4):736-42.

S G Holtan, A L Feldman, R A Knudson, R P Ketterling and L F Porrata
Failure of front-line autologous transplant in anaplastic lymphoma kinase-positive diffuse large B-cell lymphoma Bone Marrow Transplantation , (6 September 2010)

C. Hosing and R. E. Champlin Stem-cell transplantation in T-cell non-Hodgkin’s lymphomas http://annonc.oxfordjournals.org/content/early/2011/05/05/annonc.mdr140.full