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Stem Cell Transplant for B Cell Non-Hodgkin Lymphoma

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Basics of Hematopoietic Stem Cell Transplant

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Abstract

Non-Hodgkin Lymphoma (NHL) can be divided into B cell NHL and T cell NHL. B cell NHL is more common than T cell NHL. Most of the B cell NHLs are treated with chemotherapy plus rituximab. Stem cell transplantation plays an important role in the management of NHL at various phases of the disease. For diffuse large B cell lymphoma (DLBCL), follicular lymphoma, or classical Hodgkin lymphoma, autologous hematopoietic stem cell transplantation (auto-SCT) is not offered upfront but is the preferred treatment after first or subsequent relapse. In relapsed DLBCL the patient is first treated with salvage chemotherapy to reduce the disease burden and to demonstrate chemotherapy sensitivity prior to auto-SCT. There is no significant difference between R-DHAP and R-ICE as salvage therapy before auto-SCT. BEAM is the most preferred conditioning regimen for auto-SCT. For certain lymphomas, auto-SCT is the preferred front-line treatment. It is commonly offered as front-line consolidation in mantle cells and certain subtypes of mature T cell lymphomas, mainly peripheral T cell not otherwise-specified (PTCL-NOS), angioimmunoblastic T cell or ALK negative anaplastic large cell lymphomas. Allogeneic (allo) SCT provides a graft-versus-lymphoma (GVL) effect that reduces the likelihood of disease relapse following transplantation, however, it is associated with increased risk of transplant-related mortality. Currently, the major role of allo SCT in DLBCL is in the treatment of patients who have failed an auto-SCT or in whom an auto-SCT is not possible. The two most commonly used reduced intensity conditioning (RIC) regimens for allo SCT for lymphoma are fludarabine plus busulfan (FluBu) and fludarabine plus melphalan (FluMel). Treatment of mantle cell lymphoma consists of cytarabine-containing induction chemotherapy, followed by upfront auto-SCT. RIC allo SCT can be considered in patients who had failed a prior auto-SCT. In patients with chronic lymphocytic leukemia, auto-SCT fails to prevent relapse and is associated with a higher risk of secondary malignancies, therefore, allo SCT is strongly favored over auto-SCT. Auto-SCT is also considered upfront as consolidation in newly diagnosed patients with primary central nervous system lymphoma (PCNSL).

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  1. Department of Hemato-oncology and Bone Marrow Transplantation, Venkateshwar Hospital, New Delhi, Delhi, India

    Sanjeev Kumar Sharma

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Sharma, S.K. (2023). Stem Cell Transplant for B Cell Non-Hodgkin Lymphoma. In: Basics of Hematopoietic Stem Cell Transplant. Springer, Singapore. https://doi.org/10.1007/978-981-19-5802-1_23

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