Allogeneic hematopoietic cell transplantation in follicular lymphoma
- Arnold S Freedman, MD
Arnold S Freedman, MD
- Section Editor — Lymphoproliferative Disorders
- Professor of Medicine
- Harvard Medical School
- Jonathan W Friedberg, MD
Jonathan W Friedberg, MD
- Professor of Medicine
- James P Wilmot Cancer Center, University of Rochester
Follicular lymphoma (FL) is the second most common type of non-Hodgkin lymphoma (NHL). It is the most common of the indolent NHLs defined as those lymphomas in which survival of the untreated patient is measured in years. (See "Classification of the hematopoietic neoplasms".)
The initial treatment of FL depends upon the stage of disease at presentation. Patients with early stage disease may be cured with radiation therapy, while patients with advanced stage disease are initially managed with an immunotherapy-based regimen (eg, rituximab plus chemotherapy). The use of either autologous or allogeneic hematopoietic cell transplantation (HCT) in FL is controversial and the subject of ongoing clinical trials. When applied to a highly selected patient population, autologous HCT results in a disease-free survival at 10 years of approximately 40 percent and has a low treatment-related mortality rate. In comparison, allogeneic HCT may cure a higher percentage of patients with advanced stage FL, but is associated with substantial treatment-related mortality.
The use of allogeneic HCT, however, is limited since even ideal candidates who undergo allogeneic HCT have a high rate of treatment-related mortality, and because its efficacy compared with autologous HCT is not fully established. The treatment-related mortality associated with allogeneic HCT is decreasing with the advent of nonmyeloablative preparative regimens.
The use of allogeneic HCT in FL is reviewed below. The use of autologous HCT in FL and comparison with other treatment options are presented separately. (See "Autologous hematopoietic cell transplantation in follicular lymphoma" and "Initial treatment of limited stage (I/II) follicular lymphoma" and "Treatment of relapsed or refractory follicular lymphoma" and "Primary cutaneous follicle center lymphoma".)
TIMING OF TRANSPLANT
The ideal timing of hematopoietic cell transplantation (HCT) in follicular lymphoma (FL) is unknown and controversial. Ideally, allogeneic HCT should be performed within the context of a clinical trial. However, attempts to conduct randomized trials in this setting have failed. Outside of a clinical trial, HCT is reserved for patients with relapsed or refractory FL or for those with histologic transformation to a more aggressive histology. This is discussed in more detail separately. (See "Histologic transformation of follicular lymphoma" and "Treatment of relapsed or refractory follicular lymphoma", section on 'Timing'.)
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