Is It Time to Revisit the Role of Allogeneic Transplantation in Lymphoma?
Purpose of Review
A multitude of new drug and cell therapy approvals for lymphoma has prompted questions about the role of allogeneic blood or marrow transplantation (allo-BMT). We sought to review the latest evidence examining the role of allo-BMT for lymphoma in this evolving landscape.
Despite several new drug classes, there remains a large unmet need, particularly in hard to treat subtypes of lymphoma and for patients with relapsed/refractory disease. Allo-BMT can provide an opportunity for cure due to a potent graft vs lymphoma effect in high-risk relapse/refractory follicular lymphoma, mantle cell lymphoma, and aggressive T cell lymphomas. Chimeric antigen receptor T cell therapy and checkpoint blockers have improved outcomes for patients with relapsed /aggressive B cell lymphomas and Hodgkin lymphoma respectively; the role of allo-BMT consolidation in the treatment algorithm for responders to these therapies is an evolving topic.
Expanded donor availability including haploidentical relatives has improved access to allo-BMT. Non-myeloablative conditioning regimens and post-transplant cyclophosphamide prophylaxis have improved early transplant-related morbidity and rates of graft versus host disease and translated into long-term survival for patients with lymphoid malignancies. Patient selection remains key, but allo-BMT remains the only modality able to deliver durable long-term remissions across different types of lymphoma.
KeywordsAllogeneic transplant Lymphoma Diffuse large B cell lymphoma Graft-versus-lymphoma effect Graft vs host disease Hodgkin lymphoma Mantle cell lymphoma Non-Hodgkin lymphoma
Compliance with Ethical Standards
Conflict of Interest
Satish Shanbhag has received institutional research support from America Regent/Daiichi-Sankyo and participated on an advisory board for Takeda.
Nina Wagner-Johnston has participated on advisory boards for Bayer and Gilead.
Richard F. Ambinder declares that he has no conflict of interest.
Richard J. Jones declares that he has no conflict of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance
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