High-Dose Chemotherapy with Autologous Stem Cell Support in the Treatment of Transformed B-Cell Non-Hodgkin’s Lymphomas

Abstract

Malignant lymphomas are a heterogeneous group of lymphoid neoplasias of which B-cell lymphomas constitute approximately 75%. The most frequent types are follicular lymphomas and diffuse large B-cell lymphomas, both originating from lymphoid germinal centers. While follicular lymphomas most often have an indolent clinical course, diffuse large B-cell lymphomas are more aggressive and require immediate therapy. Follicular lymphomas and other indolent B-cell lymphomas transform to diffuse large – and other aggressive B-cell lymphomas at a yearly rate of 3%. B-cell lymphomas are most often treated with combined immuno-chemotherapy: anti-CD20 antibody therapy combined with cytostatic drugs. The majority of patients respond to therapy with long-lasting remissions. While the follicular lymphomas tend to relapse, diffuse large B-cell lymphomas are often cured.

Patients with histological transformation, especially in a relapsed setting, have a much more dismal prognosis with a median overall survival from transformation of 7months to 1.7years. As there is a dose-response relationship in curative lymphoma treatment, high dose therapy (HDT) with autologous stem cell support has been investigated for these lymphomas during the last 20years. No prospective randomized phase III studies have been performed, but a number of phase II studies give support for the use of HDT in this setting. In this chapter, the principles of HDT and its effect in malignant lymphomas in general are shortly reviewed while the documentation of effect and morbidity in transformed B-cell lymphomas are described in some more detail.