Upfront transplantation for poor-risk aggressive non-Hodgkin lymphoma and Hodgkin's disease: who benefits?
High-dose therapy with autologous stem-cell transplantation is the standard treatment for patients with relapsed or primary refractory Hodgkin's disease or non-Hodgkin lymphoma. The efficacy of the treatment in this setting has prompted extensive investigation of its role in upfront therapy for patients with a poor prognosis. Although the preliminary data appear promising, definitive results are still lacking, and upfront transplantation remains investigational. Newer regimens for the treatment of advanced-stage Hodgkin's disease appear to confer cure rates of approximately 85% to 90%. Thus, only a small minority of patients may potentially benefit from more aggressive therapy such as upfront transplantation. A reliable method of identifying these patients is yet to be determined. Upfront transplantation should be evaluated in these patients once they are identified.
Kewalramani
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Memorial Sloan-Kettering Cancer Center, Box 350, 1275 York Avenue, New York, NY 10021, USA.
Moskowitz
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D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018450:Disease Progression; D018380:Hematopoietic Stem Cell Transplantation; D006689:Hodgkin Disease / Q000628:therapy*; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D011379:Prognosis; D014182:Transplantation, Autologous