Stem cell transplantation for malignant lymphoma. Is it still important?

Abstract

Over the last 15 years chemotherapy and immunotherapy of indolent and aggressive B-cell lymphomas have been considerably improved, e.g. with the monoclonal anti-CD20 antibody rituximab and tyrosine kinase inhibitors, such as idelalisib. Nevertheless, autologous stem cell transplantation (SCT) after high-dose therapy remains an option for patients with relapsed or refractory lymphomas. For selected patients with B-cell lymphomas and a very unfavorable prognosis allogeneic SCT from a related or unrelated donor should be considered. This article discusses the indications for autologous SCT in patients with B-cell lymphomas based on the examples of diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) before and after the introduction of rituximab and provides an overview on the results of therapy. Indications for allogeneic SCT in patients with these entities are also discussed with reference to, among others registry studies. Before the introduction of rituximab, autologous SCT following high-dose therapy was clearly superior to chemotherapy alone in patients with relapsed or refractory DLBCL. Despite the improvement of outcomes in patients with DLBCL, 10-40 % of patients still suffer a relapse. Younger adults with relapsed chemosensitive DLBCL may achieve a long-lasting progression-free survival of approximately 50 % when autologous SCT is performed. For patients with chemosensitive relapsed FL autologous SCT also remains an option. Future studies should clarify the value of allogeneic SCT as compared to autologous SCT for younger patients with relapsed or refractory B-cell lymphomas.