The role of stem cell transplantation in the treatment of follicular lymphoma.

Follicular lymphoma (FL) is highly sensitive to chemo- and radiotherapy. However, cure can not be achieved with conventional chemotherapy. Results from several large clinical trials indicate that 50-60% of patients treated with high dose chemo-/radiotherapy (HDT) and autologous blood stem cell transplantation (SCT) for relapse after standard chemotherapy have a 3-5-year chance of disease-free survival (DFS). Overall as well as disease-free survival are improved in patients with negative results in sensitive PCR assays for the disease-specific t(14;18) translocation in bone marrow (BM) or peripheral blood samples taken after transplantation. These data compare favourably to historical results with standard dose chemotherapy. The role of high dose therapy and autologous stem cell transplantation in the primary treatment of follicular lymphoma is presently addressed in randomized trials. Patients with refractory disease or relapsing from standard as well as high dose therapy can achieve long term complete remissions (CR) with allogeneic blood stem transplantation mainly due to the graft-versus-lymphoma effect of the donor immune system.