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Allogeneic Transplantation for Follicular Lymphoma: Does One Size Fit All? J Oncol Pract 2017 12;13(12):798-806 PMID: 29232542 PMCID: PMC5728364

Pubmed ID

29232542

DOI

10.1200/JOP.2017.026336

Abstract

Follicular lymphoma (FL) exhibits striking biologic and clinical heterogeneity. Patients with newly diagnosed asymptomatic or low-bulk disease may be observed or managed with immunotherapies alone. Chemoimmunotherapy is considered a standard treatment for patients with advanced, symptomatic disease. In patients with FL who achieve at least a partial remission after first-line chemoimmunotherapy, autologous (auto-) hematopoietic cell transplantation (HCT) consolidation is not recommended; however, most patients with FL experience disease relapse after frontline therapies, with the experience of therapy failure within 2 years of first-line treatments predicting poor survival. Despite remarkable efficacy, even in patients who experience failure with other therapies, auto-HCT and allogeneic (allo-) HCT remain underutilized in relapsed/refractory FL, even among healthy and younger patients. Early use of auto-HCT consolidation should be considered a standard therapy option for high-risk patients who experience early failure of chemoimmunotherapy (< 2 years). For patients with FL who experience failure of frontline therapies late (> 2 years), deferring auto-HCT until later in the disease course is reasonable. Allo-HCT is best reserved for medically fit individuals with heavily pretreated disease, persistent marrow involvement, refractory, but low-bulk, disease, and in those who experience a failure to mobilize stem cells for auto-HCT. Allo-HCT is also a reasonable option for patients with FL who experience failure with a prior autograft; lower-intensity conditioning regimens and HLA-matched related donors are preferred in that setting. Future research should focus on the eradication of minimal residual disease before HCT and the prevention of disease relapse after HCT by integrating novel targeted agents into pre-HCT and post-HCT regimens.

Author List

Hamadani M, Horowitz MM

Authors

Mehdi H. Hamadani MD Professor in the Medicine department at Medical College of Wisconsin
Mary M. Horowitz MD, MS Center Director, Professor in the Medicine department at Medical College of Wisconsin




Scopus

2-s2.0-85039968023   3 Citations

MESH terms used to index this publication - Major topics in bold

Hematopoietic Stem Cell Transplantation
Humans
Immunotherapy
Lymphoma, Follicular
Neoplasm Recurrence, Local
Transplantation Conditioning
Transplantation, Autologous
Transplantation, Homologous
Treatment Outcome
jenkins-FCD Prod-321 98992d628744e349846c2f62ac68f241d7e1ea70