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Cellular Therapy for Follicular Lymphoma

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Follicular Lymphoma

Abstract

Despite major advances in the treatment of follicular lymphoma, the disease generally remains incurable. Novel targeted agents often require prolonged or continuous administration with issues of cost, compliance, and cumulative toxicity. Autologous stem cell transplantation results in very prolonged remissions and cure in up to 50% of patients with chemotherapy-sensitive recurrence. Recent data indicate that salvage autologous transplantation leads to improved survival for patients with early treatment failure, i.e., recurrence within 2 years after appropriate initial treatment. It may be the preferred treatment for such patients. Autologous transplantation has also been extensively investigated in the consolidation treatment of younger patients with high-risk features but has largely been abandoned in that setting because of concerns over late therapy-related MDS/AML. Purging techniques to reduce graft contamination have been associated with decreased rates of disease recurrence after autologous transplantation, as has posttransplant rituximab maintenance. Allogeneic transplantation has low rates of disease recurrence but a higher rate of complications, despite widespread use of reduced intensity conditioning. Haplo-transplant, umbilical cord blood transplant, or haplo-cord transplants are excellent graft sources for those lacking HLA-identical donors. For transformed lymphoma, autologous transplant improves survival. Novel cellular therapies including CAR-T therapy are playing an increasing role in the management of transformed B-cell lymphoma and will likely also find a role follicular lymphoma.

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Chaekal, Ok., Strati, P., van Besien, K. (2020). Cellular Therapy for Follicular Lymphoma. In: Fowler, N. (eds) Follicular Lymphoma. Springer, Cham. https://doi.org/10.1007/978-3-030-26211-2_9

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