Skip to main content

Thank you for visiting nature.com. You are using a browser version with limited support for CSS. To obtain the best experience, we recommend you use a more up to date browser (or turn off compatibility mode in Internet Explorer). In the meantime, to ensure continued support, we are displaying the site without styles and JavaScript.

  • Viewpoint
  • Published:

Who should receive myeloablative therapy for diffuse large B-cell lymphoma?

Nature Clinical Practice Oncology volume 5, pages 442–443 (2008)Cite this article

Diffuse large B-cell lymphoma (DLBCL) is the most common aggressive form of non-Hodgkin's lymphoma (NHL). At present, first-line treatment based on the combination of the anti-CD20 monoclonal antibody, rituximab, with anthracycline-based chemotherapy regimens can cure more than half of all patients with newly-diagnosed DLBCL.1 Patients who relapse or fail to attain a remission after first-line therapy have a very poor prognosis even after salvage treatment with conventional chemotherapy, with only 10% of patients surviving long term.2 We believe that high-dose therapy and autologous hematopoietic stem cell support (autologous stem cell transplantation [ASCT]) should be the standard treatment for patients with DLBCL who have relapsed after primary therapy, and should also be considered for patients who are refractory to first-line treatment and patients with histological transformation from a 'low-grade' histology. Only patients achieving at least a partial remission (PR) after the pretransplant salvage regimen, however, are likely to benefit from this procedure.3,4,5

Unfortunately, the evidence in favor of ASCT in DLBCL is not consistent across all clinical settings, namely as first-line treatment, in primary refractory disease, relapsed lymphoma and transformed lymphoma. Moreover, this evidence comes from data restricted to patients with disease refractory or relapsing after nonrituximab-containing induction therapies. Nowadays, virtually all patients with DLBCL receive front-line rituximab, and most ongoing studies of ASCT are exploring the inclusion of rituximab and/or radiolabeled antibodies in the transplant strategy.

This is a preview of subscription content, access via your institution

Access options

Buy this article

  • Purchase on Springer Link
  • Instant access to full article PDF
Buy now

Prices may be subject to local taxes which are calculated during checkout

References

  1. Pfreundschuh M et al. (2006) CHOP-like chemotherapy plus rituximab versus CHOP-like chemotherapy alone in young patients with good-prognosis diffuse large-B-cell lymphoma: a randomised controlled trial by the MabThera International Trial (MInT) Group. Lancet Oncol 7: 379–391

    Article  CAS  Google Scholar 

  2. Philip T et al. (1995) Autologous bone marrow transplantation as compared with salvage chemotherapy in relapses of chemotherapy-sensitive non-Hodgkin's lymphoma. N Engl J Med 333: 1540–1545

    Article  CAS  Google Scholar 

  3. Rodriguez J et al. (2004) Autologous stem-cell transplantation in diffuse large B-cell non-Hodgkin's lymphoma not achieving complete response after induction chemotherapy: the GEL/TAMO experience. Ann Oncol 15: 1504–1509

    Article  CAS  Google Scholar 

  4. Vose JM et al. (2001) Autologous transplantation for diffuse aggressive non-Hodgkin's lymphoma in patients never achieving remission: a report from the Autologous Blood and Marrow Transplant Registry. J Clin Oncol 19: 406–413

    Article  CAS  Google Scholar 

  5. Williams CD et al. (2001) High-dose therapy and autologous stem-cell support for chemosensitive transformed low-grade follicular non-Hodgkin's lymphoma: a case-matched study from the European Bone Marrow Transplant Registry. J Clin Oncol 19: 727–735

    Article  CAS  Google Scholar 

  6. Vose JM et al. (2004) Autologous transplant event-free survival (EFS) following failure of CHOP-Rituximab (CHOP-R) for diffuse large B-cell lymphoma (DLBCL) is the same as the EFS following failure of CHOP alone [abstract #890]. Blood 104

  7. Kewalramani T et al. (2000) High-dose chemoradiotherapy and autologous stem cell transplantation for patients with primary refractory aggressive non-Hodgkin lymphoma: an intention-to-treat analysis. Blood 96: 2399–2404

    CAS  PubMed  Google Scholar 

  8. Friedberg JW et al. (1999) Autologous bone marrow transplantation after histologic transformation of indolent B cell malignancies. Biol Blood Marrow Transplant 5: 262–268

    Article  CAS  Google Scholar 

  9. Chen CI et al. (2001) Autotransplants for histologically transformed follicular non-Hodgkin's lymphoma. Br J Haematol 113: 202–208

    Article  CAS  Google Scholar 

  10. Milpied N et al. (2004) Initial treatment of aggressive lymphoma with high-dose chemotherapy and autologous stem-cell support. N Engl J Med 350: 1287–1295

    Article  CAS  Google Scholar 

  11. Strehl J et al. (2003) High-dose chemotherapy followed by autologous stem cell transplantation as first-line therapy in aggressive non-Hodgkin's lymphoma: a meta-analysis. Haematologica 88: 1304–1315

    CAS  PubMed  Google Scholar 

  12. Greb A et al. (2007) High-dose chemotherapy with autologous stem cell support in first-line treatment of aggressive non-Hodgkin lymphoma—results of a comprehensive meta-analysis. Cancer Treat Rev 33: 338–346

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. and E Zucca is Head of the Lymphoma Unit in the Division of Medical Oncology, L Wannesson is Medical Director of the Hematopoietic Stem Cell Transplant Program, at the Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.,

    Luciano Wannesson & Emanuele Zucca

Authors
  1. Luciano Wannesson
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Emanuele Zucca
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Emanuele Zucca.

Ethics declarations

Competing interests

The authors declare no competing financial interests.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wannesson, L., Zucca, E. Who should receive myeloablative therapy for diffuse large B-cell lymphoma?. Nat Rev Clin Oncol 5, 442–443 (2008). https://doi.org/10.1038/ncponc1175

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1038/ncponc1175

Search

Advanced search

Quick links

Nature Briefing

Sign up for the Nature Briefing newsletter — what matters in science, free to your inbox daily.

Get the most important science stories of the day, free in your inbox. Sign up for Nature Briefing