Therapeutics Advances
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Sep 24, 2015; 5(3): 81-88
Published online Sep 24, 2015. doi: 10.5500/wjt.v5.i3.81
Recent advances in post autologous transplantation maintenance therapies in B-cell non-Hodgkin lymphomas
Narendranath Epperla, Timothy S Fenske, Parameswaran N Hari, Mehdi Hamadani
Narendranath Epperla, Timothy S Fenske, Parameswaran N Hari, Mehdi Hamadani, Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, United States
Author contributions: Epperla N and Hamadani M designed research; Epperla N and Hamadani M performed research; Epperla N and Hamadani M analyzed data; Epperla N, Fenske TS, Hari PN and Hamadani M wrote the paper.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Mehdi Hamadani, MD, Associate Professor, Division of Hematology and Oncology, Medical College of Wisconsin, 9200 West Wisconsin Avenue, Milwaukee, WI 53226, United States. mhamadani@mcw.edu
Telephone: +1-414-8050643 Fax: +1-414-8056815
Received: April 14, 2015
Peer-review started: April 14, 2015
First decision: May 13, 2015
Revised: May 27, 2015
Accepted: June 18, 2015
Article in press: June 19, 2015
Published online: September 24, 2015
Processing time: 163 Days and 14.3 Hours
Abstract

Lymphomas constitute the second most common indication for high dose therapy (HDT) followed by autologous hematopoietic cell transplantation (auto-HCT). The intent of administering HDT in these heterogeneous disorders varies from cure (e.g., in relapsed aggressive lymphomas) to disease control (e.g., most indolent lymphomas). Regardless of the underlying histology or remission status at transplantation, disease relapse remains the number one cause of post auto-HCT therapy failure and mortality. The last decade has seen a proliferation of clinical studies looking at prevention of post auto-HCT therapy failure with various maintenance strategies. The benefit of such therapies is in turn dependent on disease histology and timing of transplantation. In relapsed, chemosensitive diffuse large B-cell lymphoma (DLBCL), although post auto-HCT maintenance rituximab seems to be safe and feasible, it does not provide improved survival outcomes and is not recommended. The preliminary results with anti- programmed death -1 (PD-1) antibody therapy as post auto-HCT maintenance in DLBCL is promising but requires randomized validation. Similarly in follicular lymphoma, maintenance therapies including rituximab following auto-HCT should be considered investigational and offered only on a clinical trial. Rituximab maintenance results in improved progression-free survival but has not yet shown to improve overall survival in mantle cell lymphoma (MCL), but given the poor prognosis with post auto-HCT failure in MCL, maintenance rituximab can be considered on a case-by-case basis. Ongoing trials evaluating the efficacy of post auto-HCT maintenance with novel compounds (e.g., immunomodulators, PD-1 inhibitors, proteasome inhibitors and bruton’s tyrosine kinase inhibitors) will likely change the practice landscape in the near future for B cell non-Hodgkin lymphomas patients following HDT and auto-HCT.

Keywords: Mantle cell lymphoma; Diffuse large B cell lymphoma; Follicular lymphoma; Autologous hematopoietic cell transplantation

Core tip: Prevention of disease-relapse is an unmet medical need in B-cell non-Hodgkin lymphomas (NHL) undergoing autologous hematopoietic cell transplantation (auto-HCT). In this review, are summarized potentially paradigm changing advances in post auto-HCT, maintenance strategies in B-cell NHL.