[Therapy intensification with autologous transplantation in non-Hodgkin's lymphomas]

The rational for intensive chemo- or/and radiotherapy is based on the dose-effect relation in non-Hodgkin's lymphoma. In follicular lymphomas, candidates to intensification are patients with poor prognosis in relapse or with histological transformation. The efficacy of intensification to improve survival in first line treatment is not proven in follicular lymphoma. Due to the frequent marrow and blood involvement by tumoral cells in these lymphomas and the prognosis impact of this contamination, many efforts have been done to eliminate tumoral cells from the graft. Monoclonal anti-CD20 antibodies (rituximab) are indeed the best treatment to purge in vivo from tumoral cells marrow and blood. In aggressive lymphomas, intensifications are now the standard regimen in case of sensitive relapse. Probably it is also true in case of partial response or in first line after complete response in patients with 2 or 3 adverse prognostic factors. However intensification is not recommended in case of refractory disease or in first line treatment for standard-risk patients. High relapse rate after autograft justifies to test immunotherapy against minimal residual disease. The role of allogeneic transplantation, monoclonal antibodies or cytokines remains to be defined.