title: Role of Maintenance Therapy after High-Dose Chemotherapy and Autologous Hematopoietic Cell Transplantation in Aggressive Lymphomas: A Systematic Review.
abstract: Significant uncertainty exists in regard to the efficacy of maintenance therapy after high-dose chemotherapy (HDC) as well as autologous stem cell transplantation (ASCT) for the treatment of patients with aggressive lymphoma. A systematic review was performed to evaluate the effectiveness of post-ASCT maintenance therapy in patients with relapsed/refractory lymphoma. A comprehensive literature search yielded 4476 studies and a total of 42 studies (11 randomized controlled trials [RCT], 9 retrospective comparative studies, and 22 single-arm studies) were included in the systematic review. There was significant heterogeneity in study design, chemotherapeutic regimens, post-ASCT maintenance strategies, patient enrollment criteria, and study endpoints. Our findings suggest that post-ASCT maintenance immune-targeting strategies, including PD-1/PD-L1 blocking antibodies, rituximab, and brentuximab, may improve progression-free survival but not overall survival. Collectively, the results indicate a need for testing new strategies with well-designed and adequately powered RCTs to better address the role of post-ASCT maintenance in relapsed/refractory lymphomas.
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Josephine A
authors.initials: JA
authors.lastname: Taverna
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Seongseok
authors.initials: S
authors.lastname: Yun
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Jayasree
authors.initials: J
authors.lastname: Jonnadula
authors.affiliation: Arizona Health Sciences Library, University of Arizona, Tucson, Arizona.
authors.forename: Ahlam
authors.initials: A
authors.lastname: Saleh
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona.
authors.forename: Irbaz Bin
authors.initials: IB
authors.lastname: Riaz
authors.affiliation: Center for Health Outcomes and PharmacoEconomic Research, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona.
authors.forename: Ivo
authors.initials: I
authors.lastname: Abraham
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Yeager
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona.
authors.forename: Daniel O
authors.initials: DO
authors.lastname: Persky
authors.affiliation: Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona.
authors.forename: Ali
authors.initials: A
authors.lastname: McBride
authors.affiliation: Department of Hematology and Oncology, Cancer Therapy and Research Center, University of Texas Health Science Center at San Antonio, San Antonio, Texas.
authors.forename: Subrata
authors.initials: S
authors.lastname: Haldar
authors.affiliation: Department of Medicine, University of Arizona, Tucson, Arizona; Department of Hematology and Oncology, Blood and Marrow Transplantation Program, University of Arizona, Tucson, Arizona; Arizona Cancer Center, Tucson, Arizona. Electronic address: anwerf@email.arizona.edu.
authors.forename: Faiz
authors.initials: F
authors.lastname: Anwer
mesh_terms: D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008228:Lymphoma, Non-Hodgkin / Q000401:mortality / Q000628:therapy*; D060046:Maintenance Chemotherapy / Q000379:methods* / Q000592:standards; D016879:Salvage Therapy / Q000379:methods* / Q000401:mortality; D016019:Survival Analysis; D014182:Transplantation, Autologous; D016896:Treatment Outcome
keywords: Autologous hematopoietic stem cell transplantation; Hodgkin disease; Maintenance therapy; Non-Hodgkin lymphoma; Relapse