The role of allogeneic haematopoietic progenitor cell transplantation in patients with diffuse large B-cell non-Hodgkin lymphomas (DLBCL)

Abstract

Despite the undoubted improvement in the prognosis of patients with diffuse large B-cell lymphomas (DLBCLs) with the addition of rituximab in the front-line treatment, a significant proportion of patients still relapse. Salvage immune-chemotherapy followed by high-dose therapy with autologous haematopoietic cell transplantation (auto-HCT) remains the treatment of choice for such patients, especially in those who demonstrate chemosensitive disease. In recent years, allogeneic haematopoietic cell transplantation (allo-HCT) has increasingly been used for patients who are resistant to salvage treatment or relapse after an auto-HCT. Strategies using reduced intensity conditioning regimens have allowed application of this approach to a broader range of patients. PFS is up to 55% with a risk of relapse up to 80% depending on different studies. In multivariate analysis, several factors have been associated with favourable outcome including chemosensitivity of the disease, younger age and Karnofsky performance status at the time of the transplant being the strongest ones. DLIs have shown to induce durable responses in relapsed or progressed disease; however, its role remains controversial as the results are inferior to the responses seen in other haematological malignancies. More recently, the addition of MoAbs in the non-myeloablative conditioning regimens has shown encouraging results. In conclusion, allo-HCT is a feasible option in selective patients with chemosensitive DBCL, as it reduces the risk of relapse; however, this is achieved at the cost of significant non-relapse mortality.

The role of fluorine-18 fluorodeoxyglucose PET in prognosis evaluation for stem cell transplantation of lymphoma

“…On the basis of this result, NHL patients are not as urgent as HL patients to achieve a negative PET scan before transplantation. Salvage immune-chemotherapy, followed by high-dose therapy with ASCT might be considered to be a good treatment combination for DLBCL [39] as for B-cell receptor pathway inhibitors for MCL patients [40]. Recently, allogeneic hemopoietic cell transplant has increasingly been used for patients who are resistant to salvage treatment or those who developed a relapse after an ASCT.…”

Outcomes of autologous or allogeneic stem cell transplantation for non-Hodgkin lymphoma

“…The outcomes of these patients in large prospective studies are lacking and current recommendations and timing of selection of auto or allo-SCT are influenced by variety of factors including patient or disease related factors, physician preference and intuitional practices. 7–10 …”

“…On the other hand, clinical evidence of a GVL effect after allo-SCT is suggested by a plateau in relapse risk that is reached 2–5 years following allo-SCT, indicating that a substantial proportion of lymphoma patients derive long-term disease control from transplantation. 10;12;14 …”

Phase II Trial of Tandem High-Dose Chemotherapy with Autologous Stem Cell Transplantation Followed by Reduced-Intensity Allogeneic Stem Cell Transplantation for Patients with High-Risk Lymphoma

“…(5) Allogeneic hematopoietic SCT (AlloSCT) is considered in a subgroup of patients with a chemosensitive relapse after autoSCT with the goal of achieving a durable remission through an immunologically driven graft-versus-lymphoma (GVL) effect. (6)(7)(8)(9) Increasingly, reduced intensity conditioning (RIC) approaches have been employed for such patients given the overall morbidity and mortality experienced with traditional myeloablative regimens in patients with lymphoma, particularly in patients who have undergone a prior AutoSCT. Yet for patients with aggressive lymphoma, the use of RIC regimens might result in early disease relapse prior to the emergence of an effective GVL effect.…”