title: Autologous and allogeneic hematopoietic stem cell transplantation in follicular lymphoma.
abstract: BACKGROUND
  High-dose chemotherapy and autologous stem cell transplantation (ASCT) improve survival in follicular lymphoma; however, relapse remains the most common cause of death. The lower risk of relapse with allogeneic SCT (alloSCT) is offset by a high transplant-related mortality (TRM).
  
  
  METHODS
  English articles indexed in the MEDLINE database were reviewed to discuss the role of graft purging, rituximab maintenance after ASCT, reduced-intensity conditioning (RIC) alloSCT, T-cell depletion, donor lymphocyte infusion (DLI) and alternate donor sources.
  
  
  CONCLUSIONS
  Optimal salvage consolidation strategy may utilize ASCT following non-total body irradiation-based conditioning regimen in second remission. Rituximab maintenance after ASCT may improve molecular remission but is not yet shown to improve overall survival. RIC alloSCT permits its use in older and less-fit patients. Studies with T-cell depleted graft failed to reduce TRM despite a decline in graft-versus-host disease; however, these studies did demonstrate a therapeutic role of DLI in post-transplant relapses. In recent years, haploidentical and umbilical cord blood donors have emerged as alternative donor sources, with outcomes comparable to matched unrelated donor SCT. In the future, incorporation of novel therapeutic agents, improved risk-adapted treatment strategies, and advancement of transplant techniques may provide a better chance of survival.
authors.affiliation: a Department of Internal Medicine, Division of Hematology-Oncology , University of Nebraska Medical Center , 987680 Nebraska Medical Center, Omaha , NE 68198-7680 , USA.
authors.forename: V R
authors.initials: VR
authors.lastname: Bhatt
authors.affiliation: a Department of Internal Medicine, Division of Hematology-Oncology , University of Nebraska Medical Center , 987680 Nebraska Medical Center, Omaha , NE 68198-7680 , USA.
authors.forename: J O
authors.initials: JO
authors.lastname: Armitage
mesh_terms: D006086:Graft vs Host Disease / Q000517:prevention & control; D019650:Hematopoietic Stem Cell Mobilization / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D016219:Immunotherapy, Adoptive; D008212:Lymphocyte Depletion / Q000379:methods; D008224:Lymphoma, Follicular / Q000601:surgery*; D016879:Salvage Therapy / Q000379:methods; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
keywords: allogeneic hematopoietic stem cell transplantation; autologous hematopoietic stem cell transplantation; follicular lymphoma; survival