Highgrade Lymphomaburkitts Lymphoma

There have been few reports and no randomized studies evaluating the role of HDC/AHCT in patients with Burkitt's lymphoma (BL). Brief duration high-intensity chemotherapy protocols currently confer survival rates approaching 70% and HDC has not improved outcome as compared to frontline therapy.8283 Smeland et al. reported a 65% OS for newly diagnosed BL patients treated with high-intensity chemotherapy with a comparable 71% OS seen for patients who underwent AHCT in first remission. The data from the EBMT registry concurred showing a 3-year actuarial OS of 72% for 70 adult BL patients transplanted in first CR. For patients with chemosensitive relapse and resistant disease, the OS rates were 37% and 7%, respectively.84 The City of Hope reported similar results with a 3-year DFS and OS of 60% for 10 BL patients who received AHCT in first CR or PR.85 Thus, patients with recurrent or refractory BL should be channeled toward an allogeneic HCT as AHCT has been generally unsuccessful in such patients.

Lymphoblastic lymphoma is a clinically aggressive disease that accounts for only 2% of the NHLs. This clinical entity is usually composed of precursor T cells, has a predilection for young males, and frequently involves the BM and/or central nervous system.86 Because of the frequent BM involvement and its resemblance to acute lymphoblastic leukemia, allo-geneic transplantation is typically recommended in most cases. However, a recent retrospective analysis from the IBMTR/ABMTR failed to find a survival advantage for 76 patients with lymphoblastic lymphoma who received an allogeneic transplant compared to 128 patients who received an autograft.87 The 5-year OS rates were 39% vs 44%, respectively. Although the 5-year relapse rate was significantly lower in the allogeneic patients (34% vs 56%, p = 0.004), the 5-year TRM was higher in the allogeneic recipients (25% vs 5%). Independent of the source of stem cells, multivariate analysis revealed that BM involvement at the time of transplant and disease status beyond first remission were associated with inferior outcomes. Another retrospective analysis of 214 patients from the EBMT demonstrated superior outcomes for patients who received an autograft in first CR compared to patients transplanted in second CR or patients with resistant disease.88 The 6-year actuarial OS rates were 63%, 31%, and 15%, respectively. The efficacy of AHCT versus conventional dose consolidation as postremission therapy was studied in a European prospective trial of 119 patients.89 Autologous transplantation produced a trend for improved RFS but not for OS (57% and 53%, respectively) when compared to conventional dose maintenance therapy after 37 months of follow-up. Thus, both retrospective registry data and a few other series suggest that autologous transplantation can confer long-term remissions in a select group of patients.

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