Autologous transplant of follicular lymphoma in the era of rituximab

In advanced follicular lymphoma (FL), autologous stem cell transplant (ASCT) has been studied extensively in an attempt to prolong remission duration and, possibly, achieve ultimate cure. However, increasing evidence of the benefit of rituximab and various other new drugs has questioned the appropriate place of ASCT in the treatment algorithm of FL in recent years. The purpose of this overview is to propose a definition of the potential role of ASCT in the treatment armamentarium of FL in the light of these new treatment options. Taken together, the absence of an overall survival benefit, the risk of secondary malignancies, and the remarkably good prognosis of patients who receive rituximab and ASCT as salvage therapy in the relapse situation make the use of ASCT as initial therapy difficult to justify. In contrast, evidence is accumulating that, in eligible patients with relapsed FL, rituximab-based chemotherapy followed by ASCT might provide superior disease control in comparison to either modality alone, and has curative potential in a subset of patients. However, these considerations are largely based on retrospective analyses and should be confirmed in prospective randomized trials.