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An autologous transplant is very high-dose chemotherapy followed by the patient's own stored stem cells to rescue the bone marrow. CAR-T and BTK inhibitors have taken over several of its old jobs, but it is still the right answer in a shrinking list of situations.
Autologous transplant. Conditioning is usually BEAM (carmustine, etoposide, cytarabine, melphalan) or a thiotepa-based regimen for brain disease. It remains standard for: chemosensitive large B-cell lymphoma relapsing more than twelve months after first-line treatment; consolidation of first remission in primary CNS lymphoma in patients fit enough; consolidation of first remission in most nodal peripheral T-cell lymphomas; Hodgkin lymphoma relapsing after first-line therapy, after salvage to a PET-negative state; mantle cell lymphoma in younger patients, although TRIANGLE has now made that optional.
What it has lost. Second-line transplant in large B-cell lymphoma relapsing within twelve months: ZUMA-7 and TRANSFORM both beat it with CAR-T, and in ZUMA-7 only a minority of the standard-care arm ever reached transplant. Mantle cell lymphoma in first remission where an ibrutinib-containing regimen is used (TRIANGLE).
Allogeneic transplant, which uses a donor's stem cells and relies on a graft-versus-lymphoma effect, is now a small and specialised option: relapse after CAR-T in fit young patients, some T-cell lymphomas including hepatosplenic and adult T-cell leukaemia/lymphoma, and Hodgkin lymphoma after failure of both brentuximab vedotin and PD-1 blockade. It carries a treatment-related mortality of several per cent and a lasting risk of graft-versus-host disease, which is the reason it is not used more widely.
Stem cells for an autologous transplant must be collected before the marrow is damaged, which is why bendamustine and prolonged lenalidomide are avoided in anyone who may need one.
Showing the molecule this term concerns: Carmustine.
Shares Enteropathy-associated T-cell lymphoma, Thiotepa, ALK-negative anaplastic large cell lymphoma, ALK-positive anaplastic large cell lymphoma.
Shares Relapsed and refractory classical Hodgkin lymphoma, Early-stage classical Hodgkin lymphoma (stage I to II), Advanced-stage classical Hodgkin lymphoma (stage III to IV), Primary CNS lymphoma.
Shares Busulfan, Primary large B-cell lymphoma of the testis, Melphalan (including hepatic delivery system), Relapsed and refractory classical Hodgkin lymphoma.
Shares Enteropathy-associated T-cell lymphoma, Primary large B-cell lymphoma of the testis, ALK-negative anaplastic large cell lymphoma, ALK-positive anaplastic large cell lymphoma.
Shares Enteropathy-associated T-cell lymphoma, ALK-negative anaplastic large cell lymphoma, ALK-positive anaplastic large cell lymphoma, Adult T-cell leukaemia/lymphoma.
Shares PRIMA-CNS, Carmustine, Thiotepa, Cytarabine.
Shares PRIMA-CNS, Carmustine, Thiotepa, Cytarabine.
Shares Primary CNS lymphoma, Waldenström macroglobulinaemia, Burkitt lymphoma, Peripheral T-cell lymphomas (including cutaneous T-cell lymphoma).
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