The use of stem cell transplantation to treat diffuse large B-cell and follicular lymphoma

This study reviews different types of hematopoietic stem cell transplantation for patients with diffuse large B-cell lymphoma and follicular lymphoma. The study concluded that autologous and allogeneic stem cell transplantation can be used to effectively treat patients with diffuse large B-cell lymphoma and follicular lymphoma in specific contexts. 

Diffuse large B-cell lymphoma (DLBCL) and follicular lymphoma (FL) are both types of non-Hodgkin lymphoma (NHL). Hematopoietic stem cell transplantation (SCT; bone marrow transplantation) is used to treat all forms of NHL. Autologous SCT (auto-SCT) uses the patient’s own stem cells. It is the standard of care for relapsed NHL and is also used to treat slow growing cancer. For patients who relapse after auto-SCT, allogeneic SCT (allo-SCT; stem cells from a matched donor) is the only curative option. 

This study examined the role of both types of SCT in the context of DLBCL and FL. 

Diffuse large B-cell lymphoma: Auto-SCT is not generally used as first-line treatment for patients with DLBCL. Several studies have found no difference between patients receiving chemotherapy alone and those receiving chemotherapy followed by auto-SCT. For patients with high risk DLBCL, such as those with DEL or DHL, there may be some benefit to upfront auto-SCT.

For patients with relapsed or difficult to treat (refractory) DLBCL, auto-SCT is the standard of care. It has been shown to be much more effective than chemotherapy alone.

For patients who relapse after auto-SCT, allo-SCT is the standard of care. This option, used with reduced intensity conditioning (chemotherapy) before allo-SCT, can be curative.

Follicular lymphoma: Like in DLBCL, auto-SCT is not recommended as a first-line treatment. It is not associated with better survival. It is associated with increased risk of additional cancers.

For patients with relapsed or refractory FL, auto-SCT is a recommended option. It has shown longer overall survival (time from treatment to death from any cause) than chemotherapy alone. However, since the introduction of rituximab, the difference in overall survival has decreased. Many studies have shown no difference in survival between auto-SCT and chemotherapy plus rituximab.

Allo-SCT is potentially curative for patients with relapsed or refractory FL. In studies before the introduction of rituximab, allo-SCT has better outcomes than auto-SCT. A small, non-randomized study in the rituximab era shows that patients treated with allo-SCT have better outcomes than those treated with auto-SCT. 

The authors concluded that both auto- and allo-SCT are useful therapies in the treatment of both DLBCL and FL, but allo-SCT may be more effective in patients with FL. 

The decision to undergo auto- or allo-SCT for patients with follicular lymphoma is largely left up to the treating physician. Studies comparing the two in recent times are sparse. More research on the topic is needed.