Intensified chemo-immunotherapy with or without stem cell transplantation in newly diagnosed patients with peripheral T-cell lymphoma

“…However, available data does not suggest a significantly higher survival rate as indicated by a prospective study that randomized patients based on the availability of a donor to an auto-or allotransplant. 39 …”

Section: Consolidation Of First Remissionmentioning

confidence: 99%

What is the role of autologous transplant for lymphoma in the current era?

Stiff

2015

Hematology

View full text Add to dashboard Cite

The role of autologous hematopoietic stem cell transplantation (ASCT) in the management of non-Hodgkin's lymphoma (NHL) is evolving, in the era of novel agents. Multiple histologies and remission stages have been impacted with changing outcomes. In the 1990s, ASCT could cure 50% of relapsed chemosensitive aggressive NHL; now the percentage maybe as low as 20% for patients relapsing within 1 year of completing rituximab-containing induction. Yet recent trials have clarified the value of first remission ASCT for high-grade NHL, the utility of augmented preparative regimens, the efficacy of ASCT in primary CNS lymphoma and in the elderly and analyses have defined strategies to reduce transplant related myeloid malignancies. In addition, optimizing nontransplant induction therapy for mantle cell and double-hit NHL is leading to improved outcomes and a re-examination of the use of ASCT in first complete remission. Caution is needed, however, as delaying transplants may mean that patients will need more morbid allogeneic transplants to achieve long-term control of refractory disease. As an alternative, maintenance therapy trials to improve ASCT outcome in high-risk patients are starting, based on the efficacy of lenolidomide and brentuximab in myeloma and Hodgkin's lymphoma, respectively. In addition, efforts to define early high-risk patients by minimal residual disease (MRD) assessments and genetic profiling, are beginning even for those with "indolent" phenotypes not currently autotransplanted. These efforts should not only refine but also enhance the value of early potentially curative ASCT, especially if novel agents only delay but do not prevent relapse for patients with NHL. Learning Objectives• To understand the evolution of ASCT for lymphoma over the past 5 years considering the incorporation of novel agents into induction and salvage therapy • To discuss approaches to the use of ASCT in both first and second remission NHL • To update recently completed and planned trials for this form of therapy in NHL

show abstract

“…[170][171][172][173] Currently, the role of consolidation therapy in ALCL is controversial. A prospective study to evaluate upfront ASCT in patients with PTCL (N = 62) included 19 patients with ALKpositive ALCL.…”

Section: First-line Therapymentioning

confidence: 99%