title: Allogeneic stem cell transplantation in follicular lymphoma.
abstract: Myeloablative allogeneic transplantation in follicular lymphoma has been found to be particularly effective in patients with relapsed disease and an inadequate bone marrow reserve or massive bone marrow involvement. Allogeneic transplantation carries the promise of long-term disease control by graft-versus-lymphoma immunity but is associated with a 30%-40% risk of transplant-related mortality. Nonmyeloablative stem cell transplantation exploits the graft-versus-lymphoma effect without the attendant toxicity of myeloablative conditioning. The results of several recent reports suggest that it has a high likelihood of resulting in long-term disease-free survival in patients up to 70 years of age with a good performance status, chemotherapy-sensitive disease, and HLA-matched sibling donors. At The University of Texas MD Anderson Cancer Center, the standard NST conditioning regimen for patients with follicular lymphoma is fludarabine, cyclophosphamide, and rituximab. This regimen results in a transplantation-related mortality rate of 10%, and 85% of patients are alive without disease at 8 years. In this article, we discuss the current issues in NST for follicular lymphoma, including chemosensitivity, conditioning intensity, graft-versus-host disease, donor lymphocyte infusion's role, and ongoing strategies to treat refractory disease.
authors.affiliation: Department of Stem Cell Transplantation and Cellular Therapy, Unit 423, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd., Houston, TX 77030, USA. ikhouri@mdanderson.org
authors.forename: Issa F
authors.initials: IF
authors.lastname: Khouri
mesh_terms: D000818:Animals; D058846:Antibodies, Monoclonal, Murine-Derived / Q000276:immunology / Q000627:therapeutic use*; D001853:Bone Marrow / Q000187:drug effects / Q000473:pathology; D003520:Cyclophosphamide / Q000008:administration & dosage*; D018572:Disease-Free Survival; D006086:Graft vs Host Disease / Q000517:prevention & control; D020350:Graft vs Tumor Effect; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006801:Humans; D008224:Lymphoma, Follicular / Q000276:immunology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D051379:Mice; D019653:Myeloablative Agonists / Q000008:administration & dosage; D012008:Recurrence; D012074:Remission Induction; D012307:Risk Factors; D000069283:Rituximab; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D014740:Vidarabine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D058846:Antibodies, Monoclonal, Murine-Derived; D006680:HLA Antigens; D019653:Myeloablative Agonists; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine