Why aren't we performing more allografts for aggressive non-Hodgkin's lymphoma?

Abstract

Summary:Allogeneic stem cell transplantation has an underappreciated role in the management of intermediate-grade non-Hodgkin's lymphoma. It provides several advantages over autologous stem cell transplantation including provision of a lymphoma-free graft, reduced rates of secondary myelodysplastic syndrome and leukemia, and a potentially curative graft-versus-lymphoma effect. When applied to chemosensitive patients, the lower relapse rates and reasonable long-term outcomes make allogeneic transplantation a promising therapy to pursue. Patient populations, such as those with bone marrow involvement or very high-risk disease, can be identified as having suboptimal outcomes after autotransplantation and may benefit from such an approach. While the exact role of allogeneic stem cell transplantation remains to be determined, broad recommendations can be suggested for the management of patients with intermediate-grade lymphoma. New approaches to allogeneic transplantation, including the use of matched-unrelated donors and reduced-intensity conditioning regimens, may expand the applicability of this potentially curative modality. Bone Marrow Transplantation (2003) 31, 953-960.

High-dose treosulfan in patients with relapsed or refractory high-grade lymphoma receiving tandem autologous blood stem cell transplantation

“…[27][28][29] Further, the monoclonal antibody rituximab has the potential to improve the treatment results in relapsed or refractory B-cell lymphoma on several levels; first, at initial cytoreductive treatment for rapid induction of remission, second, for in vivo stem cell purging, and lastly, during or after HDT for the maintenance of remission. [30][31][32] In conclusion, the feasibility to include treosulfan into a high-dose combination regimen has been demonstrated.…”

A Comparison of HLA-Identical Sibling Allogeneic versus Autologous Transplantation for Diffuse Large B Cell Lymphoma: A Report from the CIBMTR

“…Autologous HCT, however, is less effective in patients with chemoresistant relapse (10–13). This observation often is explained by an increase in relapse risk due to a lack of graft-versus-lymphoma effect and because of re-infusion of malignant cells (4, 5, 14–16). Allogeneic HCT, usually employing bone marrow as the stem cell source, is a potential therapeutic option especially for patients with matched sibling donors and higher risk disease.…”

Hematopoietic stem cell transplantation in peripheral T-cell lymphomas

“…Comparative trials of autologous versus allogeneic SCT presents some selection bias because usually patients enrolled in allograft cohort have more advanced disease, more prior therapies and/or bone marrow involvement. However, these studies demonstrated that allografting induced a lower relapse risk as compared with autologous SCT, but the high NRM offset any survival benefit [29]. In a retrospective study Rodriguez et al evaluated the outcome of patients receiving autologous (n ¼ 29) or allogeneic SCT (n ¼ 7) for PTCL: the 3-year overall survival was 39% and 29%, respectively.…”