Historical Perspective Autologous Stem Cell Transplantation

Although many non-Hodgkin's lymphoma (NHL) histologic subtypes can be cured using combination chemotherapy, many patients experience relapse or never achieve remission after initial therapy. For several decades, high-dose chemoradiation therapy and autologous stem cell transplantation (auto SCT), using either autologous bone marrow or, subsequently, autologous peripheral blood stem cells (auto PBSC), has been demonstrated to be an effective therapy for sensitive-relapse NHL patients.1-3 This modality can also be effective in refractory relapse or even primary refractory disease states.4 5 Some investigators have reported data supporting a recommendation for use of auto SCT in NHL patients at high risk for relapse.67 Obvious benefits of auto SCT are use of self as a donor, no need for posttransplant immunosuppression and its attendant risks, and the avoidance of graft-versus-host disease (GvHD). On the other hand, this modality usually is ineffective in the setting of significant tumor bulk, cannot be offered to patients who have been subjected to extensive previous treatment limiting mobilization of blood stem cells,8 and lacks graft-versus-lymphoma (GvL) effect. The major limitation of auto SCT is relapse after transplant, due, in part, to intrinsic lymphoma resistance to cytotoxic agents and the potential for reinfusion of occult tumor cells that may contribute to relapse.9 In vitro purging methods indirectly have been shown to provide benefit in some patients, but the results are not conclusive.1011 The prognosis after relapse in auto SCT recipients is extremely poor.

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