Nonmyeloablative stem cell transplantation in follicular B-cell lymphoma

Myeloablative allogeneic stem cell transplantation carries the promise of long-term disease control by graft-versus-lymphoma (GVL) immunity but is associated with a 30% to 40% risk of transplant-related mortality. Nonmyeloablative stem cell transplantation (NST) aims to exploit the GVL effect without the attendant toxicity of myeloablative conditioning. At the M.D. Anderson Cancer Center, the standard NST conditioning regimen for patients with follicular lymphoma is fludarabine, cyclophosphamide, and rituximab (FCR). Using this regimen, transplant-related mortality is currently 10%, and 85% of patients remain alive without disease at 3 to 4 years. This review discusses the current issues in NST for follicular lymphomas, including the optimization of conditioning intensity, the use of rituximab in immunomodulation, and the role of donor lymphocyte infusion.