The Role of Autologous and Allogeneic Stem Cell Transplantation in Follicular Lymphoma in the New Drugs Era.

Abstract

Follicular lymphoma (FL) is the second most common histotype of non-Hodgkin’s lymphoma, and it is generally characterized by a heterogeneous clinical course. Despite recent therapeutic and diagnostic improvements, a significant fraction of FL patients still relapsed. In younger and/or fit FL relapsed patients bone marrow transplant (BMT) has represented the main salvage therapy for many years. Thanks to the ability of high-dose chemotherapy to overcome the lymphoma resistance and refractoriness, autologous stem cell transplantation (ASCT) can achieve a high complete remission rate (CR) and favorable outcome regarding progression-free survival (PFS) and overall survival (OS). Allogeneic stem cell transplantation (alloSCT) combines the high dose chemotherapy effect together with the immune reaction of the donor immune system against lymphoma, the so-called ‘graft versus lymphoma’ (GVL) effect. Considering the generally higher transplant-related mortality (TRM), alloSCT is mostly indicated for FL relapsed after ASCT. During the last years, there have been a great spread of novel effective and feasible drugs Although these and future novel drugs will probably change our current approach to FL, the OS post-BMT (ASCT and alloSCT) has never been reproduced by any novel combination. In this scenario, it is important to correctly evaluate the disease status, the relapse risk and the comorbidity profile of the relapsed FL patients in order to provide the best salvage therapy and eventually transplant consolidation.

Comparison of Survival Between Autologous and Allogeneic Stem Cell Transplantation in Patients with Relapsed or Refractory B-Cell Non-Hodgkin Lymphoma: A Meta-Analysis

“…Auto-SCT can achieve a high rate of complete remission and favorable OS and PFS outcomes. However, considering the generally higher TRM associated with allo-SCT, allotransplant is indicated primarily for FL relapse after ASCT 36 . In recent years, the use of allo-HCT has increased for patients who are resistant to salvage treatment or who have relapsed after an auto-HCT 37 .…”

Impact and Intricacies of Bone Marrow Microenvironment in B-cell Lymphomas: From Biology to Therapy

“…As such, HCT has become a fairly common therapeutic option in DLBCL, FL and MCL, especially in R/R disease. HCT can be broadly classified into two types depending on the source of stem cells, auto-HCT (autologous, patient-derived) and allo-HCT (allogenic, donor-derived) [104]. Auto-HCT is an integral component of frontline treatment in MCL with improved outcomes when employed in CR1 (Complete Remission 1), although there are no randomized data comparing auto-HCT vs. no auto-HCT in CR1 at this time.…”