Integrating Novel Therapies into Treatment of B-Cell Malignancies - Episode 10

Stem Cell Transplantation in Follicular Lymphoma

Stem cell transplantation is not typically recommended as part of a patient’s initial therapy for follicular lymphoma due to the availability of other effective frontline treatments. It is considered as a treatment option in younger patients who have relapsed disease, states Brad S. Kahl, MD. Patients over the age of 70 are not usually candidates for stem cell transplantation, Kahl adds.

An autologous transplant relies on high-dose chemotherapy and is a common strategy for patients with recurrent follicular lymphoma in their second or third remission. An allogeneic transplant has curative potential, unlike drug therapy, and relies on a new immune system. Upfront risk is a main challenge facing transplantation, considering that research has shown a nearly 20% treatment related mortality within the first 2 years, Kahl notes. Allogeneic transplant should be reserved for patients who are deriving a suboptimal benefit from standard treatments, explains Kohl.

The optimal duration of maintenance therapy in follicular lymphoma is generally considered to be 2 years. Data suggests a small incremental benefit with increasing the duration to 5 years, but this benefit probably does not warrant an extra 3 years of treatment, comments Kahl.