Autologous Hematopoietic Cell Transplantation For Nonhodgkins Lymphoma

Ginna G. Laport and Robert S. Negrin

Non-Hodgkin's lymphoma (NHL) is the fifth most common cancer among men and women with a projected incidence of over 54,000 new cases in the United States in 2004.1 Many patients with NHL can be cured today with frontline combination chemotherapy and/or radiotherapy. However, for patients with suboptimal responses to initial therapy or for patients with relapsed or refractory disease, salvage therapy alone is typically inadequate to achieve long-term survival.23 Fortunately, high-dose chemotherapy (HDC) with autologous hematopoietic cell transplantation (AHCT) offers curative potential. Dose-intensive treatment has unequivocally been shown to be the treatment of choice for patients with relapsed, chemosensitive, intermediate-grade lymphomas, and recent data have shown that a certain subset of these patients benefit from AHCT while in first remission. Until recently, HDC had not consistently yielded durable responses for patients with relapsed indolent lymphoma but new data showing a survival advantage was recently reported.4 However, the role of AHCT and the appropriate timing in such entities as mantle cell lymphoma (MCL), the T-cell lymphomas, and high-grade lymphomas remains controversial. This chapter will discuss the application of HDC with AHCT in NHL and review emerging advances such as the role of rituximab (RTX) for in vivo purging and posttransplant maintenance therapy and the use of radioimmunotherapy (RIT) in the preparative regimen.

0 0

Post a comment