Mantle cell lymphoma (MCL) and peripheral T-cell lymphomas (PTCL) are rare subtypes of non-Hodgkin’s lymphoma that together comprise <5% of all cases of NHL in adults. Both diseases are associated with poor outcomes with standard front line NLH chemotherapy. Additionally, investigations into new therapies for MCL and PTCL have been historically difficult due to their rarity.
Pre-transplant conditioning can significantly influence post-transplant outcomes. A strong anti-tumor effect achieved by myeloablative conditioning (MAC) is frequently counterbalanced by higher morbidity and non-relapse mortality, particularly in older adults. On the other hand, reduced intensity conditioning (RIC) is associated with lower post-transplant mortality, but may not be sufficient enough to prevent relapse, particularly in patients with persistent and aggressive malignances.
According to the American Cancer Society, it was estimated in 2011 there were 44,600 cases of leukemia, 66,360 cases of non-Hodgkin lymphoma, 8,830 cases of Hodgkin lymphoma, and 20,520 cases of myeloma diagnosed for the first time. In addition, the Leukemia and Lymphoma Society estimates that one person is diagnosed with a blood cancer approximately every four minutes in the U.S. The outcome for patients with hematologic malignancies has dramatically changed with the use of novel therapies.
For those who did not practice hematopoietic cell transplantation (HCT) at the time, it may be difficult to appreciate the impact that mobilized peripheral blood stem cells (PBSC) have had on the pace of hematologic recovery. In the days before mobilized PBSC, count recovery before day +21 was uncommon, and prolonged neutropenia resulted in a risk of death from infection that exceeded 5%.
The management of mantle cell lymphoma and T-cell lymphoma remains a challenge for many oncologists. Unlike the more common follicular or diffuse-large B-cell lymphomas, there is a paucity of prospective controlled trials, and there are no standards for the management of these diseases. Practice patterns can vary considerably from center to center.
The treatment of acute myelogenous leukemia (AML) has 2 steps: the first step involves therapy to get it into remission, and the second step involves therapy to prevent it from coming back. Over several decades our approach to the first step has largely remained the same, but our approach to the second step has evolved significantly. The fundamental clinical decision for the second step has become: is the prospect for durable control better with posttransplantation chemotherapy or with hematopoietic cell transplantation?