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Reappraisal of autologous stem cell transplantation for transformed indolent lymphoma in the bendamustine era

Bone Marrow Transplantation volume 59, pages 1618–1620 (2024)Cite this article

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Histologic transformation (HT) to diffuse large B-cell lymphoma (DLBCL) occurs in up to 5–10% of patients with indolent B-cell non-Hodgkin lymphoma (iNHL) [1]. While HT arising from treatment-naïve iNHL has a similar prognosis as de novo DLBCL [2], survival rates are considerably lower at 20–55% among those who develop HT after receiving chemotherapy for iNHL [3,4,5,6]. Although autologous stem cell transplantation (ASCT) is recommended for patients with HT arising from chemotherapy-exposed iNHL [7], most studies evaluating the outcomes of ASCT for HT were conducted before the establishment of bendamustine-rituximab (BR) as a preferred first-line therapy for iNHL [8,9,10]. Patients with progression of disease within 24 months (POD24) of BR have a particularly poor prognosis with a high incidence of HT [6], but the optimal management of these patients, including the role of ASCT, remains unclear [7].

This retrospective population-based study included consecutive patients 18–70 years old who previously received chemotherapy for follicular lymphoma grades 1–3A, marginal zone lymphoma, lymphoplasmacytic lymphoma, or nodular lymphocyte predominant B-cell lymphoma and were intended for ASCT for biopsy-proven HT in Alberta, Canada between 2005 and 2021. Treatment protocols and statistical analyses are described in the Supplement. This study was approved by the Health Research Ethics Board of Alberta.

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Fig. 1: Survival of patient population.

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Data may be made available from the authors upon reasonable request.

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Authors and Affiliations

  1. Alberta Health Services and University of Calgary, Calgary, AB, Canada

    Colin Stewart, Carolyn Owen, Mona Shafey, Sarah Perry, Peter Duggan, Douglas Stewart & Robert Puckrin

  2. Alberta Health Services and University of Alberta, Edmonton, AB, Canada

    Russell Sterrett, Anthea Peters & Neil Chua

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  1. Colin Stewart
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  2. Carolyn Owen
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  3. Mona Shafey
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  9. Douglas Stewart
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Contributions

CS and RP designed the study, performed the research, analyzed the data, and wrote the paper. CO, SP, RS, AP, PD, NC, and DS analyzed the data and wrote the paper.

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Correspondence to Colin Stewart.

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Stewart, C., Owen, C., Shafey, M. et al. Reappraisal of autologous stem cell transplantation for transformed indolent lymphoma in the bendamustine era. Bone Marrow Transplant 59, 1618–1620 (2024). https://doi.org/10.1038/s41409-024-02399-9

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