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Expert Opinion on Biological Therapy Volume 16, 2016 - Issue 1
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Reviews

Autologous and allogeneic hematopoietic stem cell transplantation in follicular lymphoma

VR BhattDepartment of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE68198-7680, USA
&
JO ArmitageDepartment of Internal Medicine, Division of Hematology-Oncology, University of Nebraska Medical Center, 987680 Nebraska Medical Center, Omaha, NE68198-7680, USACorrespondence[email protected]
Pages 57-66 | Published online: 29 Oct 2015

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  • Papers of special note have been highlighted as either of interest (•) or of considerable interest (••) to readers.
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•• This is a multicenter randomized trial in rituximab era that demonstrates a lack of OS benefit despite PFS improvement with upfront HDT/ASCT over chemoimmunotherapy

  • Lenz G, Dreyling M, Schiegnitz E, et al. Myeloablative radiochemotherapy followed by autologous stem cell transplantation in first remission prolongs progression-free survival in follicular lymphoma: results of a prospective, randomized trial of the German Low-Grade Lymphoma Study Group. Blood. 2004;104(9):2667–2674.
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• This is a multicenter randomized trial in pre-rituximab era that demonstrates a lack of OS benefit despite EFS improvement with upfront HDT and purged ASCT over chemoimmunotherapy, and a risk of secondary malignancy among recipients of purged ASCT

  • Sebban C, Mounier N, Brousse N, et al. Standard chemotherapy with interferon compared with CHOP followed by high-dose therapy with autologous stem cell transplantation in untreated patients with advanced follicular lymphoma: the GELF-94 randomized study from the Groupe d’Etude des Lymphomes de l’Adulte (GELA). Blood. 2006;108(8):2540–2544.
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• Although a retrospective study, this is a large EBMT registry study that demonstrates a plateau in PFS curve with HDT/ASCT. The study provides useful prognostic information and also indicates a risk of secondary myeloid neoplasms with the use of TBI-based conditioning regimen

  • Ferro RA, Bhatt VR, Smith L, et al. Long-term outcomes of rituximab use prior to autologous stem cell transplant (ASCT) in low-grade follicular lymphoma (FL) at the time of first progression ASCO 2015 Annual Meeting May 29-June 2. J Clin Oncol. 2015;33(suppl; abstr 7036).
  • Kothari J, Peggs KS, Bird A, et al. Autologous stem cell transplantation for follicular lymphoma is of most benefit early in the disease course and can result in durable remissions, irrespective of prior rituximab exposure. Br J Haematol. 2014;165(3):334–340.
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  • Arcaini L, Montanari F, Alessandrino EP, et al. Immunochemotherapy with in vivo purging and autotransplant induces long clinical and molecular remission in advanced relapsed and refractory follicular lymphoma. Ann Oncol. 2008;19(7):1331–1335.
  • Van Besien K, Loberiza FR Jr., Bajorunaite R, et al. Comparison of autologous and allogeneic hematopoietic stem cell transplantation for follicular lymphoma. Blood. 2003;102(10):3521–3529.

• This large international registry-based study compares the outcomes of autologous versus allogeneic hematopoietic stem cell transplantation in pre-rituximab era

  • Pettengell R, Schmitz N, Gisselbrecht C, et al. Rituximab purging and/or maintenance in patients undergoing autologous transplantation for relapsed follicular lymphoma: a prospective randomized trial from the Lymphoma Working Party of the European Group for Blood and Marrow Transplantation. J Clin Oncol. 2013;31(13):1624–1630.

•• This randomized trial demonstrates a lack of survival benefit of pretransplantation rituximab in vivo purging. Additionally, it highlights the presence of PFS advantage with rituximab maintenance after HDC/ASCT

  • Hicks LK, Woods A, Buckstein R, et al. Rituximab purging and maintenance combined with auto-SCT: long-term molecular remissions and prolonged hypogammaglobulinemia in relapsed follicular lymphoma. Bone Marrow Transplant. 2009;43(9):701–708.
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• This CIBMTR study provides useful comparison of myeloablative versus reduced-intensity conditioning allogeneic transplant

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