Non-Hodgkin Lymphoma (NHL)
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 2008 and 2016.
Figure 1. Unrelated Donor HCT in Adult NHL
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Advances
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 clinical factors and/or molecular techniques to ascertain which patients would benefit most from transplantation [3,4]
- New research indicating that autologous or reduced-intensity allogeneic HCT is beneficial in chemotherapy-sensitive patients with mantle cell lymphoma. [5]
Outcomes
Improved Survival
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.
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Figure 3.
One- and two-year overall survival in adult NHL, allogeneic unrelated transplants facilitated by NMDP/Be The Match, with prior autologous HCT.
Download slide "NHL Survival Over Time, Unrelated HCT, 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
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Figure 5. NHL Survival, Unrelated PBSC HCT, by Disease Status
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Figure 6. NHL Survival, Unrelated HCT, Non-Myeloablative, by Cell Source
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Figure 7. NHL Survival, HCT using RIC/Non-Myeloablative Preparative Regimen, with Prior Autologous HCT, by Cell Source
Figure 8. NHL Survival, Unrelated Marrow HCT, with Prior Autologous HCT, by Disease Status
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Figure 9. NHL Survival, Unrelated PBSC HCT, with Prior Autologous HCT, by Disease Status
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Figure 10. Diffuse Large B-Cell Lymphoma Survival, Autologous HCT, by Disease Status
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Figure 11. Diffuse Large B-Cell Lymphoma Survival, Sibling HCT, by Disease Status
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Figure 12. Follicular Lymphoma Survival, By Disease Status and Donor Type
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Figure 13. Follicular Lymphoma Survival, Autologous HCT, by Disease Status
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Figure 14. Mantle Cell Lymphoma Survival, HCT, by Donor Type
Download slide "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. [5]
Transplant Consultation Guidelines: NHL
Follicular
- Poor response to initial treatment
- Initial remission duration <24 months
- First relapse
- Transformation to diffuse large B-cell lymphoma
Diffuse Large B-Cell
- Primary induction failure, including residual PET avid disease
- First relapse
- CR2 or subsequent remission
- Double or triple hit (MYC and BCL-2 and/or BCL-6) – at diagnosis
- Primary CNS lymphoma at diagnosis
High Grade
- C-myc rearrangement at diagnosis
- Primary induction failure
- CR1
- First relapse
- CR2 or subsequent remission
Mantle T-Cell
- At diagnosis
- First relapse
- Bruton's tyrosine kinase (BTK) intolerant or resistant disease
Mature T-Cell
- CR1
- First relapse
Other High-Risk Lymphomas
- At diagnosis
CAR T Cell Therapy Video for Patients
In this easy-to-understand video, Linda J. Burns, M.D., Vice President, Health Services Research, and Scott Kerwin, R.N., M.N., C.C.R.C., C.C.R.N., Clinical Trial Patient Education Specialist, explain what CAR T cell therapy is, who it may help, what the treatment is like, potential risks and benefits, questions to ask your doctor, and more.
In this easy-to-understand video, Linda J. Burns, M.D., Vice President, Health Services Research, and Scott Kerwin, R.N., M.N., C.C.R.C., C.C.R.N., Clinical Trial Patient Education Specialist, explain what CAR T cell therapy is, who it may help, what the treatment is like, potential risks and benefits, questions to ask your doctor, and more. View the video and share it with patients and caregivers who are looking for information on CAR T therapy as a treatment option.
References
- NCCN Guidelines Version 3.2018 B- and T-Cell Lymphomas. Access B-cell guidelines (PDF) • Access T-cell guidelines (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
- Sureda A, Zhang M-J, Dreger P, et al. Allogeneic hematopoietic stem cell transplantation for relapsed follicular lymphoma: A combined analysis on behalf of the Lymphoma Working Party of the EBMT and the Lymphoma Committee of the CIBMTR. Cancer. 2018; 124(8): 1733-1742. 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 and ASBMT Recommended Timing for Transplant Consultation. Download (PDF)