Second hematopoietic SCT for lymphoma patients who relapse after autotransplantation: another autograft or switch to allograft?
Although autologous hematopoietic SCT (auto-HSCT) is the only potentially curative treatment for lymphoma that has relapsed after conventional chemotherapy, the prognosis of patients with disease recurrence after auto-HSCT is poor. Some highly selected patients can benefit from second transplants. One-third with late recurrence after initial auto-HSCT may attain a prolonged remission after second auto-HSCT. Non-myeloablative or reduced-intensity conditioning (RIC) allogeneic hematopoietic SCT (allo-HSCT) has been used successfully after auto-HSCT failures, especially in subjects who have an HLA-compatible donor, chemosensitive disease and good performance status. Patients with chemosenstive disease recurrence who have completed at least 1 year after their first auto-HSCT should be considered for a second auto-HSCT. Patients who have chemoresistant disease are best served by participation in a well-designed clinical trial examining novel antitumor agents.
Freytes
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CO
South Texas Veterans Health Care System, San Antonio, TX, USA. Freytes@uthscsa.edu
Lazarus
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HM
D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D008223:Lymphoma / Q000517:prevention & control / Q000628:therapy*; D008297:Male