About 60% of patients with Diffuse Large B Cell Lymphoma respond well to treatment and achieve a cure. However, among the refractory group, the prognosis is unfavorable. Bone marrow transplantation is still the standard treatment applied to these patients, while new alternatives are being developed.
Article: DUFFLES, G.; DE SOUZA, C. Transplant in Diffuse Large B-Cell Lymphoma.
Brazilian Journal of Transplantation, 2022. 25(02):e0422. https://doi.org/10.53855/bjt.v25i2.445_en
Diffuse large B cell lymphoma: What is the best treatment?
Aggressive lymphomas manifest rapidly, causing constitutional symptoms and lymph node enlargement. The most common and well-known type of aggressive lymphoma is diffuse large B-cell lymphoma (DLBCL), usually diagnosed in patients around age 65-75. In general, it is curable, but of a dangerous relapse, where only half of the patients will respond to secondary treatment or have the clinical conditions to take high-dose therapy.
Researchers from the Hematology and Hemotherapy Center of the Faculty of Medical Sciences of the Universidade Estadual de Campinas, in Brazil, present the article "Transplant in Diffuse Large B-Cell Lymphoma", published in v.25 n.2 of the Brazilian Journal of Transplantation, aiming to bring a review of the literature on the treatments currently applied to the relapsed/refractory population of DLBCL.
Since the 1990s, in most medical centers around the world, autologous transplantation, when feasible, has been consolidated as a standard treatment for lymphomas. Autologous transplantation uses high-dose salvage chemotherapy with the patient's own stem cells. Allogeneic transplantation depends on a different stem cell from a compatible donor, causing a graft-versus-lymphoma (GVL) effect. This immune response must fight the cancer cells, but it can take time, which may not always be available, depending on the disease situation at the time of transplantation.
There is also an increased risk of non-recurrence-related mortality, development of infections, or graft-versus-host disease (GVHD). Even so, allogeneic transplantation is still reserved for multirefractory cases in an attempt at remission and cure.
With the continuous advance in the knowledge of the disease and the development of new technologies, the focus is on the search for low toxicity treatments. The advent of CAR-T cell therapy, mentioned in the article, has brought impressive results in patients with multi-refractory DLBCL, which already calls into question the choice of autologous transplantation in the treatment of cure. In allogeneic transplantation, toxicity rates are now lower than ever before. Even so, it is to be expected that transplants will continue to be the standard treatment of second-line therapy, while science advances, which justifies the importance of constantly updating studies in this area.
Read more (References):
National Cancer Institute. Cancer stat facts: NHL – diffuse large B-cell lymphoma (DLBCL) [Internet]. National Cancer Institute [cited on Dec, 2017]. Available at: https://seer.cancer.gov/statfacts/html/dlbcl.html
Robinson, S.P.; Boumendil, A.; Finel, H.; Blaise, D.; Poiré, X.; Nicolas-Virelizier, E. et al. Autologous stem cell transplantation for relapsed/refractory diffuse large B-cell lymphoma: efficacy in the rituximab era and comparison to first allogeneic transplants. A report from the EBMT Lymphoma Working Party. Bone Marrow Transplant, 2016;51(3):365-71. https://doi.org/10.1038/bmt.2015.286
Rigacci, L.; Puccini, B.; Dodero, A.; Iacopino, P.; Castagna, L.; Bramanti, S. et al. Allogeneic hematopoietic stem cell transplantation in patients with diffuse large B cell lymphoma relapsed after autologous stem cell transplantation: A GITMO study. Ann Hematol, 2012;91(6):931-9 https://doi.org/10.1007/s00277-011-1395-9
Links
Universidade Estadual de Campinas - Faculdade de Ciências Médicas
Brazilian Journal of Transplantation
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