Non-Hodgkin lymphomas (NHL) are a highly heterogeneous group of lymphoproliferative disorders originating in B lymphocytes, T lymphocytes, or natural killer (NK) cells. In the United States, B-cell NHL represents 80-85% of cases; T-cell NHL, 15-20%; and NK NHL is rare. Most hematopoietic cell transplantation (HCT) performed for NHL is autologous, but in some cases, physicians may perform allogeneic HCT for particularly high-risk relapsed or refractory disease. [1,2]
Figure 1 shows the increase by age group in the number of unrelated donor transplants facilitated by the National Marrow Donor Program® (NMDP)/Be The Match for adults with NHL between 2001 and 2012.
Figure 1. Unrelated Donor HCT in Adult NHL
The outlook for patients with NHL has steadily improved over the last decade due to several clinical advances, including:
- Increased use of reduced-intensity conditioning regimens for older patients and those with comorbidities to reduce transplant-related mortality
- More refined prognostication using molecular techniques to ascertain which patients would benefit most from transplantation 
- New research indicating that autologous or reduced-intensity allogeneic HCT is beneficial in chemotherapy-sensitive patients with mantle cell lymphoma. 
A Case-Based Approach to CLL and Mantle Cell Lymphoma
View this CME activity, which explores the challenges with evolving therapies for patients with CLL and MCL. What are the optimal approaches using conventional chemotherapy, novel agents, as well as transplantation?
Figure 2 shows the outcomes of unrelated donor transplantation for patients with NHL. Between 2001 and 2012, one-year survival increased 13%, and two-year survival increased 12%. Since 1990, one-year survival has increased 24% and two-year survival has increased 22%. 
Figure 2. NHL Survival Over Time, Unrelated HCT, with No Prior Autologous HCT
One- and two-year overall survival in adult NHL, allogeneic unrelated transplants facilitated by NMDP/Be The Match, with no prior autologous HCT.
Figure 3. NHL Survival Over Time, Unrelated HCT, with Prior Autologous HCT
One- and two-year overall survival in adult NHL, allogeneic unrelated transplants facilitated by NMDP/Be The Match, with prior autologous HCT.
Allogeneic and Autologous Transplant Outcomes
Review outcomes for allogeneic and autologous transplantation in patients with NHL below. View additional NHL slides showing demographic data and transplant trends. Data in this section have been prepared by CIBMTR® (Center for International Blood and Marrow Transplant Research), our research program.
Figure 4. NHL Survival, Unrelated Marrow HCT, by Disease Status
Figure 5. NHL Survival, Unrelated PBSC HCT, by Disease Status
Figure 6. NHL Survival, Unrelated HCT, Non-Myeloablative, by Cell Source
Figure 7. Diffuse Large B-Cell Lymphoma Survival, Autologous HCT, by Disease Status
Figure 8. Diffuse Large B-Cell Lymphoma Survival, Sibling HCT, by Disease Status
Figure 9. Follicular Lymphoma Survival, Sibling HCT, by Disease Status
Figure 10. Follicular Lymphoma Survival, Autologous HCT, by Disease Status
Figure 11. Mantle Cell Lymphoma Survival, HCT, by Donor Type
Referral Timing Guidelines
These guidelines highlight disease categories that include patients at risk for disease progression and who should be referred for a consultation for autologous or allogeneic transplantation. 
Transplant Consultation Guidelines: NHL
- Poor response to initial treatment
- Initial remission duration <12 months
- First relapse
- Transformation to diffuse large B-cell lymphoma
Diffuse Large B-Cell or High-Grade Lymphoma
- At first or subsequent relapse
- CR1 for patients with high or high-intermediate IPI risk
- No CR with initial treatment
- Second or subsequent remission
- After initiation of therapy
Other High-Risk Lymphomas
- After initiation of therapy
- NCCN Guidelines Version 1.2013 Non-Hodgkin's Lymphomas. Access (PDF)
- Dreyling M, Ferrero S, Hermine O. How to manage mantle cell lymphoma. Leukemia. 2014; 28(11): 2117-2130. Access
- Oliansky DM, Gordon LI, King J, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of follicular lymphoma: An evidence-based review. Biol Blood Marrow Transplant. 2010; 16(4): 443-468. Access
- Fenske TS, Zhang M-J, Carreras J, et al. Autologous or reduced-intensity conditioning allogeneic hematopoietic cell transplantation for chemotherapy-sensitive mantle-cell lymphoma: Analysis of transplantation timing and modality. J Clin Oncol. 2014; 32(4): 273-281. Access
- NMDP/Be The Match data analysis, 2013.
- NMDP/ASBMT Recommended Timing for Transplant Consultation, 2015. Download (PDF)