Intensification with autologous transplantation in non-Hodgkin's lymphomas

The rational for intensive chemo- or/and radiotherapy is based on the dose- effect relation in non-Hodgkin's lymphoma. In follicular lymphomas, candida tes to intensification are patients with poor prognosis in relapse or with histological transformation. The efficacy of intensification to improve sur vival ire first line treatment is not proven ire follicular lymphoma. Due t o the frequent marrow and blood involvement by tumoral cells in these lymph omas and the prognosis impact of this contamination, many efforts have been done to eliminate tumoral cells from the graft. Monoclonal anti-CD20 antib odies (rituximab) are indeed the best treatment to purge in vivo from tumor al cells marrow and blood In aggressive lymphomas, intensifications are now the standard regimen in case of sensitive relapse. Probably it is also tru e in case of partial response or in first line after complete response inpa tients with 2 or 3 adverse prognostic factors. However intensification is n ot recommended in case of refractory disease or in first line treatment for standard-risk patients. High relapse rate after autograft justifies to tes t immunotherapy against minimal residual disease. The role of allogeneic tr ansplantation, monoclonal antibodies or cytokines remains to be defined.