Biomedical Engineering Reference
In-Depth Information
vera (PV), and essential trombocythemia (ET), allogeneic SC transplant can be a
therapeutical option, but depending on the risk factors and disease stage [ 63 ] . The
allogeneic SC transplant should only be considered in patients with intermediate and
high risk scores for OMF, since their expected median survival is less than 2 years. In
patients with PV and ET occurrence of marrow fibrosis is the main criterion for allo-
geneic transplant. The use of RIC regimens resulted in less TRM and remision in 75%
of the patients [ 64 ] .
Chronic Lymphoproliferative Diseases
Hodgkin lymphoma . Newly diagnosed Hodgkin lymphoma (HL) although in advanced
stage has good prognosis with standard chemotherapy. In patients with chemosensi-
tive relapse or in second CR high-dose therapy (HDT) and autologous SC transplant
is nowadays considered to be the therapy of choice [ 65 ] . Also, in primary refractory
disease, autologous SC transplant is an option. Allogeneic SC transplant is still an
experimental procedure for patients with relapsed or refractory HL [ 66 ] .
High-grade non-Hodgkin lymphoma (NHL) . The outcome of patients with high-
grade NHL is unsatisfactory with standard approaches [ 67 ] . These patients may be
candidates for front-line HDT and autologous SC transplant, but in first relapse.
Approximately half of this patient can be cured with immunochemotherapy, usually
R-CHOP. In younger patients with relapsed or refractory chemosensitive disease,
HDT can be curative in a significant subset. But in the era of rituximab combining
with chemotherapy, autologous and allogeneic SC transplant is optional. Other
strategies to improve the outcome of the patients are currently being explored. In
Diffuse large B cell lymphoma (DLBCL) the addition of rituximab to pre- and post-
transplant therapy is promising [ 68 ]. The role of allogeneic SC transplant remains
uncertain in high-grade NHL. The use of RIC can reduce TRM but evidence of
significant graft versus lymphoma is lacking.
Low-grade NHL. Folicular lymphoma (FL) is by far the most common low-grade
lymphoma, accounting for 20% of malignant lymphoma in adults, but 40% of all
lymphomas diagnosed in Western Europe and the USA. Based on FL international
prognostic index (FLIPI), therapeutic outcome on standard immunochemotherapy
is different [ 69, 70 ]. The use of HDT with autologous SC transplant in the treatment
of low-grade NHL has not yet been established. The rationale for considering trans-
plantation is that disease is incurable using standard therapies, and young patients
will die of their disease. Using consolidation with autologous SC transplant in first
remission demonstrated no statistically significant benefit in favor of first-line autol-
ogous SC transplant in patients with FL, and it should be reserved for relapsed
patients [ 70 ]. As concerning allogeneic SC transplant, it is not recommended in first
CR due to high rate of TRM and long disease course. It can be used in relapsed
patients with RIC regimens, consisting of alemtuzumab, fludarabine, and melphalan
with short-course cyclosporin as GvHD prophylaxis.
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