Autologous stem cell transplantation in lymphomas: current indications

Abstract

Hematopoietic stem cell transplantation is an established curative treatment for a number of conditions including malignant hematologic diseases and non-malignant congenital and acquired disorders involving the hematopoietic system and some types of solid tumors, e.g. germ cell tumors and soft tissue sarcomas. Hodgkin’s disease and non-Hodgkin lymphomas can be treated and, in a large number of cases cured, by first-line chemotherapy or radiotherapy. Unlike many other malignancies, relapse is not uniformly fatal but the treatment is usually markedly myelotoxic with the high doses of chemotherapy (HDC) used in relapse. Hematopoietic reconstitution with either autologous marrow or peripheral stem cells post-chemotherapy has made HDC relatively safe, with mortality rates as low as 2% in some centers. The choice of conditiong regimen has traditionally been based on institutional experience, and several regimens are considered standard and routinely used for patients with all histologies of lymphoma. Each HDC regimen is associated with its own unique toxicities, based on the individual agents or modalities used. Novel targeted and immunotherapy approaches, including chimeric antigen receptor T-cell therapy, are currently being studied in clinical trials with promising early results, so the role of autologous stem cell transplantation in the treatment of lymphomas could be changed. The current clinical indications for HDC followed by autologous hematopoietic stem cell transplantation in lymphomas management for patients with a bad prognosis (as a consolidation therapy) or relapsed/refractory disease are reviewed in this paper.