Hematopoietic Stem Cell Transplantation for Non-Hodgkin's Lymphoma

It has been demonstrated that complete molecular remission in follicular lymphoma is associated with an improved outcome. Therefore, the object of modern therapy for indolent lymphoma should be to achieve this goal. Strategy for Improved Outcome
Conventional alkylating agent or anthracycline-based chemotherapy does not produce a complete molecular remission, even in patients with a complete clinical response. On the contrary, novel treatments that include fludarabine (Fludara)-based combination regimens and rituximab(Drug information on rituximab) (Rituxan) have been associated with substantial complete molecular remission rates. Similarly, in vitro autologous stem cell purging to determine bcl-2 polymerase chain reaction (PCR) negativity also demonstrate encouraging results. Thus, in patients without compatible donors, our strategy should maximize the complete molecular remission rate and improve overall survival in patients with follicular lymphoma. To achieve this objective, rituximab should be used prior to highdose therapy to reduce the lymphoma clone. For patients with an HLAidentical sibling, indolent lymphomas represent a good target for the allogeneic transplant effect. Unfortunately, conventional allografting is penalized by a transplant-related mortality of 40% to 50%, which is the reason that nonmyeloablative stem cell transplantation is now used increasingly, especially in older patients and those with comorbid medical problems. Conclusions
In conclusion, I agree with the authors that patients with HLA sibling donors and poor-risk factors according to the International Prognostic Index may have a survival advantage with nonmyeloablative stem cell transplant when disease recurs after a first or second complete response. The main problem with these transplants is the acute and chronic graft-vs-host disease that can worsen quality of life in these patients. The results achieved with nonmyeloblative transplants in this population are generally better than those seen in patients with aggressive lymphomas. In the next few years, the emphasis should be on performing tandem transplants (auto/mini-allo), first employed by our team in 1997 in patients with Hodgkin's disease and non-Hodgkin's lymphoma.[1]