Hematopoietic Stem Cell Transplantation for Patients with Advanced-Stage Follicular Lymphoma
Tontanai Numbenjapon MD*, Auayporn Nademanee MD**
Affiliation : * Division of Hematology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand ** Division of Hematology and Hematopoietic Cell Transplantation, City of Hope Comprehensive Cancer Center, Duarte, California, USA
Patients with advanced-stage follicular lymphoma (FL) are considered to be incurable and eventually relapse after conventional chemotherapy. High-dose therapy (HDT) followed by autologous hematopoietic stem cell transplantation (AHSCT) can unequivocally prolong the disease-free survival (DFS) but not overall survival (OS) in the first complete remission and in a salvage setting. Recently, the incorporation of rituximab and radioimmunoconjugates in HDT with AHSCT seems to be promising and widely accepted. Although allogeneic hematopoietic stem cell transplantation (alloHSCT) consistently demonstrates longer DFS compared with historical controls of HDT followed by AHSCT, this approach cannot be considered as a standard of care due to its unacceptably high treatment-related mortality (TRM) and the lack of improving OS. With highly encouraging results and less TRM, the role of nonmyeloablative hematopoietic stem cell transplantation (NMHSCT), especially after AHSCT, needs to be validated in randomized controlled trials with a long-term follow-up.
Keywords : Follicular lymphoma, Autologous hematopoietic stem cell transplantation, Allogeneic hemato- poietic stem cell transplantation, Nonmyeloablative hematopoietic stem cell transplantation
