Role of Maintenance Therapy after High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation in Aggressive Lymphomas: A Systematic Review

Abstract

Significant uncertainty exists in regard to the efficacy of maintenance therapy after high-dose chemotherapy (HDC) as well as autologous stem cell transplantation (ASCT) for the treatment of patients with aggressive lymphoma. A systematic review was performed to evaluate the effectiveness of post-ASCT maintenance therapy in patients with relapsed/refractory lymphoma. A comprehensive literature search yielded 4476 studies and a total of 42 studies (11 randomized controlled trials [RCT], 9 retrospective comparative studies, and 22 single-arm studies) were included in the systematic review. There was significant heterogeneity in study design, chemotherapeutic regimens, post-ASCT maintenance strategies, patient enrollment criteria, and study endpoints. Our findings suggest that post-ASCT maintenance immune-targeting strategies, including PD-1/PD-L1 blocking antibodies, rituximab, and brentuximab, may improve progression-free survival but not overall survival. Collectively, the results indicate a need for testing new strategies with well-designed and adequately powered RCTs to better address the role of post-ASCT maintenance in relapsed/refractory lymphomas.

Autologous Graft-versus-Tumor Effect: Reality or Fiction?

“…Our group also reported that non-Hodgkin's lymphoma patients with higher expression of interleukin-15 at day 15 after autologous hematopoietic stem cell transplantation was associated with natural killer (NK) cell recovery and survival with a 5-year overall survival rates of 79% versus 47% and 5-year progression-free survival rates of 63% versus 31% for patients with an interleukin-15 equal to or greater than 76.5 pg/mL compared with less than 76.5 pg/mL at day 15 after autologous hematopoietic stem cell transplantation, respectively [9]. As maintenance therapy after autologous hematopoietic stem cell transplantation is currently undergoing clinical trials [10], our findings could provide a platform for the development of postautologous hematopoietic stem cell transplantation cytokine therapy to target specific host immunity effector cells to improve clinical outcomes in autologous hematopoietic stem cell transplantation.…”

A Review of Autologous Stem Cell Transplantation in Lymphoma

“…There are several trials that continue to evaluate the role of ASCT or allo-SCT [13,14] as well as tandem transplantation [15] for aggressive lymphoma. In a study by Taverna and colleagues (2016) relapse prevention strategies after ASCT consolidation were reviewed in great detail [16]. In this brief review, we will focus on the current trends and evidence for the use of HDC and ASCT for NHL, HL and PTCL.…”

Brentuximab vedotin for treatment of non-Hodgkin lymphomas: A systematic review

“…Such combinations need to be tested based on pathologically active intracellular mechanism in each disease subtype. BV needs to be further studied in the setting of autologous and allogenic HSCT for CD30 + malignancies to prevent post-HSCT relapse (Taverna et al, 2016; Gopal et al, 2012). …”