Controversies in lymphoma: The role of hematopoietic cell transplantation for mantle cell lymphoma and peripheral T cell lymphoma

Mantle cell lymphoma (MCL) and peripheral T cell lymphoma (PTCL) are distinct lymphoma subtypes that each comprise about similar to 10% of the non-Hodgkin lymphomas. Although both subtypes are characterized by high remission rates to frontline chemotherapy, the prognosis is generally poor because of inevitable relapse within 1-2 years or less, depending on the specific histology. Patients with MCL who achieve a complete remission with upfront conventional chemotherapy currently have several options for consolidative therapy including maintenance therapy with rituximab, autologous hematopoietic cell transplantation (HCT), and more recently, allogeneic HCT utilizing a reduced intensity conditioning (RIC) regimen. In the autologous HCT setting, the added efficacy of rituximab is under active investigation as a method of in vivo purging during hematopoietic cell mobilization, as part of the conditioning regimen and as post-HCT maintenance therapy. For patients, with PTCL, autologous HCT is commonly offered at relapse but there are a few prospective series utilizing autologous HCT as consolidation of CRI with encouraging results. There is no conclusive evidence regarding the efficacy of allogeneic HCT, but outcomes with RIC regimens appear promising. This review summarizes the current role of HCT for patients with MCL in first remission and for patients with PTCL as consolidation and for relapsed/refractory disease. (C) 2008 American Society for Blood and Marrow Transplantation.