High-dose therapy for follicular lymphoma

Most patients with advanced-stage follicular non-Hodgkin's lymphoma (NHL) a re not cured with conventional therapy. The use of high-dose therapy and au tologous stem-cell transplantation in patients with relapsed follicular NHL has received increasing attention. Several large studies suggest a disease -free survival rate of approximately 40% among patients transplanted during sensitive relapse, although the role of autologous transplantation in firs t remission remains controversial, Patients with histologic transformation from low-grade to diffuse large B-cell lymphoma whose disease remains sensi tive to conventional therapy have a similar disease-free survival rate, All ogeneic transplantation has achieved relapse, overall survival, and treatme nt-related death rates of approximately 15%, 50%, and 40%, respectively, in patients with follicular NHL. Studies of minimal residual disease suggest that the presence of lymphoma cells in the autologous graft and within the patient before clinically apparent relapse is predictive of later recurrenc e. Therefore, treatment of minimal residual disease may improve the outcome of high-dose therapy. Use of a tumor-free stem-cell product through improv ed purging or allogeneic stem cells is one approach, although the morbidity and mortality of allogeneic transplantation remain high. Immunomodulatory strategies with monoclonal antibodies, vaccines, or adoptive immunotherapy may be particularly well suited to patients at high risk for relapse follow ing high-dose therapy.