Indications for hematopoietic stem cell transplantation in patients with follicular lymphoma

A study was recently been published with the objective to define the indications for hematopoietic stem cell transplantation in patients with Follicular lymphoma (FL). Until now, it has been difficult to define the role of stem cell transplant in the treatment of FL patients. This difficulty is from the fact that the outcome for FL patients has improved.

This study was done through consensus method, due to lack of randomized trials in this area. Consensus based data are valuable tools when there is no evidence based data. Twelve panel members were selected on the basis of their expertise in the field, with a balanced distribution of ‘lymphoma’ and ‘transplant’ experts. Sixteen statements on the subject were selected, and each participant rated the statement on a 9-point scale, from strongly disagree being 1 and 9 being strongly agree. After 2 rounds of judging the statements, consensus was reached or not on each statement.

The main conclusion in the study is that high-dose therapy with autologous stem cell rescue, abbreviated as HDT-ASCR, plays a significant role in the treatment of relapsed FL patients, even in the rituximab era.  A conclusion was also reached to support HDT-ASCR in patients with relapsed FL, as well as to consider this treatment in first relapse, and more specifically in patients with poor-risk features like short response time, which are poor risk factors at recurrence in the pre rituximab era. There was also partial consensus reached to recommend HDT-ASCR in first relapse in patients previously treated with rituximab, since these patients would not been considered ‘high risk’ since their previous treatment did not consist of both rituximab and chemotherapy. For other cases and consensuses reached, please check out the full article at the link below.

The panelists came to an agreement that the available biological and genetic risk factors are not yet sufficient to guide treatment decisions including the indication for HDT-ASCR and allogeneic transplantation in FL, and that instead, these should be guided by the clinical course.

Indications for hematopoietic stem cell transplantation in patients with follicular lymphoma: a consensus project of the EBMT-Lymphoma Working Party.
Montoto S, Corradini P, Dreyling M, Ghielmini M, Kimby E, López-Guillermo A, Mackinnon S, Marcus RE, Salles G, Schouten HC, Sureda A, Dreger P.

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