The role of a BMT in the treatment of NHL and the type of BMT recommended is dependent upon:
the age of the patient
the identification of a suitable donor
the disease grade
the disease's response to standard therapy
the presence of lymphoma cells in the blood or bone marrow
BMT in Indolent (Low-Grade) NHL
Low-grade NHL is associated with long survival with standard chemotherapy treatments. Therefore only patients whose disease has recurred or not responded completely to multi-drug chemotherapy are candidates for a blood and marrow transplant. Since low-grade NHL frequently involves the patient's own bone marrow and because a donor bone marrow may have anti-lymphoma properties in its own right, in Vancouver only related or unrelated donor BMT is considered for this disease.
The current Vancouver experience suggests that while the procedure is associated with significant risk, donor blood and marrow transplant may cure up to 50% of patients.
If the patient is considered to be at high risk for recurrence, a number of centres have used BMT, usually autologous rather than donor BMT, to treat patients with intermediate-grade NHL in first complete remission.
However, the vast majority of patients with intermediate-grade NHL receive high-dose therapy with a BMT only if the disease recurs after standard chemotherapy. This approach is based upon strong evidence supporting survival being superior with high-dose therapy in recurrent intermediate-grade NHL. In Vancouver, patients are given a dose of a standard salvage chemotherapy treatment at the time of recurrence to ensure that they still have "responsive" lymphoma. If no response is seen, patients DO NOT proceed to a BMT.
Most patients having a BMT for intermediate-grade NHL will have their own (autologous) stem cells used. However, younger, fit patients with a history of bone marrow involvement with NHL, or a poor response to standard chemotherapy, may be considered for a donor blood and marrow transplant. This assumes that a suitable donor has been identified.
In general, 30-40% of patients with recurrent intermediate-grade NHL can be cured with high-dose therapy and an autologous or a donor bone marrow transplant.
Patients with high-grade or mantle cell lymphomas are usually treated with standard chemotherapy initially then rapidly proceed to "consolidation" with high-dose therapy and BMT while in first remission.
If the bone marrow was involved with lymphoma at diagnosis, a donor BMT may be considered.
For Burkitt's, Burkitt's-like and lymphoblastic lymphomas, more than 50% of patients having a BMT in first remission have been cured.
Experience with mantle cell NHL is less extensive. It is thought that the BMT using autologous stem cells will increase survival but not lead to cures.