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Induction of Alloantigen-specific Anergy in Human Peripheral Blood Mononuclear Cells by Alloantigen Stimulation with Co-stimulatory Signal Blockade

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Autologous stem cell transplantation for aggressive lymphomas.

Giuseppe Visani¹, Paola Picardi, Patrizia Tosi

¹Hematology and Stem Cell Transplant Center, AORMN, Pesaro, Italy.

Mediterranean Journal of Hematology and Infectious Diseases

|December 4, 2012

Summary

High-dose therapy with autologous stem cell transplant (HDT/ASCT) is debated for aggressive non-Hodgkin lymphoma (NHL). Recent studies show it offers no survival benefit over standard therapy when Rituximab is included.

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Area of Science:

Hematology
Oncology
Clinical Trials

Background:

High-dose therapy (HDT) followed by autologous stem cell transplantation (ASCT) was a standard for relapsed aggressive non-Hodgkin lymphoma (NHL).
The introduction of Rituximab has challenged the role of HDT/ASCT in first-line therapy.
Previous studies demonstrated HDT/ASCT superiority over conventional chemotherapy in chemosensitive, relapsed patients before Rituximab.

Purpose of the Study:

To evaluate the current role and effectiveness of HDT/ASCT in aggressive B- and T-cell non-Hodgkin lymphoma (NHL).
To assess the impact of Rituximab on the outcomes of HDT/ASCT.
To explore novel strategies for improving HDT/ASCT outcomes in aggressive NHL.

Main Methods:

Review of clinical studies and trials investigating HDT/ASCT in aggressive NHL.
Comparison of outcomes (disease-free survival, overall survival) between HDT/ASCT and conventional salvage therapies.
Analysis of data from the pre-Rituximab era and the Rituximab era.

Main Results:

HDT/ASCT showed superiority over conventional chemotherapy in the pre-Rituximab era for relapsed NHL.
When Rituximab was added to both HDT/ASCT and standard therapy arms, no significant survival benefit was observed for HDT/ASCT.
The superiority of HDT/ASCT over conventional salvage therapy was not confirmed in patients relapsing from Rituximab-containing first-line therapy.
Consolidation with HDT/ASCT is feasible in T-cell lymphoma, but relapse remains a concern.

Conclusions:

The role of HDT/ASCT in aggressive NHL is increasingly debated, especially with the advent of Rituximab.
Novel strategies are needed to enhance the efficacy and reduce the toxicity of HDT/ASCT.
Despite challenges, HDT/ASCT remains a consideration for T-cell lymphoma, though relapse is still a significant issue.