Lymphoma
Hematopoietic stem cell transplantation
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For Adults
with Malignant
Lymphoma
Getting
Stem Cell
Transplant -
Stem Cell
Transplant
Treatment -
Results
of Stem Cell
Transplantation
When is hematopoietic stem cell transplantation required for adult malignant lymphoma?
In adults battling malignant lymphoma, a crucial treatment option is autologous hematopoietic stem cell transplantation. Specifically for those with non-Hodgkin's lymphoma, this transplantation is considered when there is more than just a partial response following the initial standard chemotherapy. The patient also must meet one of certain additional conditions.
- Disorder of bulky at mantle cell lymphoma stage II
- Among diffuse large B cell lymphoma patients, higher LDH and Ann Arbor stage III/IV
- Burkitt Lymphoma (low-risk complete remission excluded)
- Extranodal NK/T-cell Lymphoma (nasal type (stage I complete remission excluded))
Even in patients in complete remission after standard primary chemotherapy, non-Hodgkin’s lymphoma with high malignancy and high recurrence rate, according to the pathological subtypes, is treated by autologous hematopoietic stem cell transplantation to minimize the relapse.
- Peripheral T-cell Lymphoma (ALK(+), Anaplastic Large Cell Lymphoma excluded)
- Primary CNS Lymphoma
In the case of unresponsive or recurrent disease after standard chemotherapy, salvage chemotherapy can be performed; if the results show more than a partial response, and one of the following conditions exist, autologous hematopoietic stem cell transplantation is performed.
- Follicular Lymphoma, Marginal Zone Lymphoma
- Lymphoplasmacytic Lymphoma/Waldenstrom’s Macroglobulinemia
- Lymphoblastic Lymphoma
- Mantle cell Lymphoma
- Diffuse Large B cell Lymphoma
- Burkitt Lymphoma
- Peripheral T-cell Lymphoma
- Extranodal NK/T-cell Lymphoma
- Primary CNS Lymphoma
In case of Hodgkin’s lymphoma, autologous hematopoietic stem cell transplantation is performed when the disease is unresponsive to and recurrent after standard chemotherapy and more than partially responsive to salvage chemotherapy.
Allogeneic hematopoietic stem cell transplantation
In the treatment of Hodgkin's lymphoma, allogeneic hematopoietic stem cell transplantation is selectively used when the disease recurs after autologous transplantation, or for patients with a poor prognosis who may require the allogeneic procedure following autologous transplantation.
For non-Hodgkin's lymphoma, allogeneic transplantation is considered in the following scenarios: when consolidation therapy is recommended after standard primary chemotherapy in high-risk, relapsed patients; when the final response to standard primary chemotherapy is not complete remission, and there is a high risk of relapse following autologous transplantation; and when the disease recurs after autologous transplantation but shows more than a partial response to salvage chemotherapy. The preparatory treatment and use of immunosuppressants for allogeneic transplantation are the same as in acute myeloid leukemia cases.
While the recurrence rate of lymphoma after allogeneic transplantation is significantly lower than with autologous transplantation, the risk of complications from the procedure is higher. Therefore, the overall treatment outcomes may not be superior to those of autologous transplantation, and it is not routinely performed. Currently, allogeneic transplantation in adult lymphoma patients is selectively performed only when the disease recurs primarily after autologous transplantation, or in patients with poor prognosis who are unresponsive to initial treatments.
Treatment outcomes of hematopoietic stem cell transplantation for adult malignant lymphoma
At our Hematology Hospital, we carefully select patients for autologous hematopoietic stem cell transplantation. This selection process includes patients who have achieved partial or complete remission after standard primary chemotherapy. This approach has been effective in reducing the recurrence rate by 15-20%. To further enhance the success of the transplantation, we use a pre-treatment therapy known as Busulfan-Melphalan-Thiotepa. This therapy helps to reduce the toxicity of chemotherapy and increase the rate of successful engraftment. In addition, we utilize a system called CliniMACS. This system has been shown to significantly reduce the recurrence rate following autologous hematopoietic stem cell transplantation. The use of these strategies has visibly improved the survival rates after transplantation in patients with adult lymphoma who are in the high-risk group or have highly malignant pathological subtypes.