Controversies in the treatment of lymphoma with autologous transplantation

Alison J. Moskowitz, Craig Moskowitz

Research output: Contribution to journalReview article

13 Citations (Scopus)

Abstract

High-dose therapy and autologous stem cell transplant (HDT-ASCT) is the standard of care for relapsed and refractory diffuse large B cell lymphoma and Hodgkin's lymphoma; however, the role for HDT-ASCT in the treatment of follicular lymphoma (FL), mantle cell lymphoma (MCL), and peripheral T cell lymphoma (PTCL) is controversial. In FL, phase II and randomized data support the use of HDT-ASCT in the relapsed setting and incorporation of rituximab into mobilization regimens and post-transplant maintenance appears to prolong remission durations. Allogeneic stem cell transplant remains the only curative treatment option and is appropriate for patients with high bone marrow disease burdens and refractory disease. In MCL, HDTASCT is most often administered up front, and phase II studies using intense immunochemotherapy followed by HDT-ASCT in first complete response (CR) have shown the most impressive outcomes. Complicating the situation, however, are data supporting up-front intensive immunochemotherapy without HDT-ASCT consolidation as well as a "watch and wait" strategy for selected patients. Finally, in PTCL, phase II data support treat-ment with HDT-ASCT in first CR, and it is rarely appropriate in the relapsed setting. Furthermore, disease status at the time of transplant likely impacts outcome; however, this needs to be evaluated further. Overall, HDT-ASCT is an important element of the treatment of relapsed FL and untreated MCL and PTCL; however, large prospective studies are needed to confirm its role and identify the most optimal induction, mobilization, and maintenance regimens for each disease.

Original languageEnglish (US)
Pages (from-to)921-929
Number of pages9
JournalOncologist
Volume14
Issue number9
DOIs
StatePublished - Sep 1 2009
Externally publishedYes

Fingerprint

Autologous Transplantation
Lymphoma
Transplants
Stem Cells
Peripheral T-Cell Lymphoma
Mantle-Cell Lymphoma
Follicular Lymphoma
Therapeutics
Bone Marrow Diseases
Maintenance
Lymphoma, Large B-Cell, Diffuse
Standard of Care
Hodgkin Disease
Prospective Studies

Keywords

  • Follicular lymphoma
  • Hematopoietic stem cell transplantation
  • Mantle cell lymphoma
  • Peripheral T cell lymphoma

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Controversies in the treatment of lymphoma with autologous transplantation. / Moskowitz, Alison J.; Moskowitz, Craig.

In: Oncologist, Vol. 14, No. 9, 01.09.2009, p. 921-929.

Research output: Contribution to journalReview article

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