Recent progress: hematopoietic cell transplant for diffuse large B-cell lymphoma

Diffuse large B-cell lymphoma (DLBCL) is the most common non-Hodgkin lymphoma histology, with 40% of patients cured with frontline therapy. Salvage chemotherapy followed by autologous hematopoietic cell transplant (HCT) remains the standard of care for relapsed or primary refractory patients who are chemosensitive. Autologous HCT in first remission is not recommended, as randomized trials have not shown a survival benefit. Despite evidence for a graft versus lymphoma effect, allogeneic HCT is often reserved for patients with DLBCL who have persistent marrow involvement, have failed autologous HCT or have primary refractory disease. Reduced intensity or non-myeloablative conditioning regimens carry a lower non-relapse mortality risk as compared to myeloablative conditioning but are associated with higher relapse. Patients with DLBCL with the dual translocations of BCL2 and MYC or "double hit" lymphoma carry a poor prognosis, and HCT is often offered as consolidation therapy. Further studies are needed to determine whether HCT can alter the natural history of this aggressive subtype.