title: Allogeneic Hematopoietic Cell Transplantation as Curative Therapy for Patients with Non-Hodgkin Lymphoma: Increasingly Successful Application to Older Patients.
abstract: Non-Hodgkin lymphoma (NHL) constitutes a collection of lymphoproliferative disorders with widely varying biological, histological, and clinical features. For the B cell NHLs, great progress has been made due to the addition of monoclonal antibodies and, more recently, other novel agents including B cell receptor signaling inhibitors, immunomodulatory agents, and proteasome inhibitors. Autologous hematopoietic cell transplantation (auto-HCT) offers the promise of cure or prolonged remission in some NHL patients. For some patients, however, auto-HCT may never be a viable option, whereas in others, the disease may progress despite auto-HCT. In those settings, allogeneic HCT (allo-HCT) offers the potential for cure. Over the past 10 to 15 years, considerable progress has been made in the implementation of allo-HCT, such that this approach now is a highly effective therapy for patients up to (and even beyond) age 75 years. Recent advances in conventional lymphoma therapy, peritransplantation supportive care, patient selection, and donor selection (including the use of alternative hematopoietic cell donors), has allowed broader application of allo-HCT to patients with NHL. As a result, an ever-increasing number of NHL patients over age 60 to 65 years stand to benefit from allo-HCT. In this review, we present data in support of the use of allo-HCT for patients with diffuse large B cell lymphoma, follicular lymphoma, and mantle cell lymphoma. These histologies account for a large majority of allo-HCTs performed for patients over age 60 in the United States. Where possible, we highlight available data in older patients. This body of literature strongly supports the concept that allo-HCT should be offered to fit patients well beyond age 65 and, accordingly, that this treatment should be covered by their insurance carriers.
authors.affiliation: Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin. Electronic address: tfenske@mcw.edu.
authors.forename: Timothy S
authors.initials: TS
authors.lastname: Fenske
authors.affiliation: Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, Wisconsin; Center for International Blood and Marrow Transplant Research, Milwaukee, Wisconsin.
authors.forename: Mehdi
authors.initials: M
authors.lastname: Hamadani
authors.affiliation: Department of Hematology and Medical Oncology, Emory University, Winship Cancer Institute, Atlanta, Georgia.
authors.forename: Jonathon B
authors.initials: JB
authors.lastname: Cohen
authors.affiliation: Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, Alabama.
authors.forename: Luciano J
authors.initials: LJ
authors.lastname: Costa
authors.affiliation: Division of Oncology, Washington University School of Medicine, St. Louis, Missouri.
authors.forename: Brad S
authors.initials: BS
authors.lastname: Kahl
authors.affiliation: Division of Hematology/Oncology, Tufts Medical Center, Boston, Massachusetts.
authors.forename: Andrew M
authors.initials: AM
authors.lastname: Evens
authors.affiliation: Department of Medicine, Memorial Sloan Kettering Cancer Center, and Department of Medicine, Weill Medical College of Cornell University, New York Presbyterian Hospital, New York, New York.
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hamlin
authors.affiliation: Division of Hematology-Oncology, Department of Medicine, University Hospitals Case Medical Center, Case Western Reserve University, Cleveland, Ohio.
authors.forename: Hillard M
authors.initials: HM
authors.lastname: Lazarus
authors.affiliation: Division of Medical Oncology, University of Washington School of Medicine, and Division of Clinical Research, Fred Hutchinson Cancer Research Center, Seattle, Washington.
authors.forename: Effie
authors.initials: E
authors.lastname: Petersdorf
authors.affiliation: Blood and Marrow Transplant Program, Ottawa Hospital Research Institute at University of Ottawa, Ottawa, Ontario, Canada.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bredeson
mesh_terms: D000368:Aged; D046148:Donor Selection / Q000639:trends; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods* / Q000639:trends; D006801:Humans; D008224:Lymphoma, Follicular / Q000628:therapy; D016403:Lymphoma, Large B-Cell, Diffuse / Q000628:therapy; D020522:Lymphoma, Mantle-Cell / Q000628:therapy; D008228:Lymphoma, Non-Hodgkin / Q000628:therapy*; D008875:Middle Aged; D014184:Transplantation, Homologous
keywords: Allogeneic hematopoietic cell transplantation; Elderly; Non-Hodgkin lymphoma; Reduced-intensity conditioning