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Semin Hematol. 2014 Jan;51(1):73-86. doi: 10.1053/j.seminhematol.2013.11.005. Epub 2013 Nov 15.

Management of relapses after hematopoietic cell transplantation in T-cell non-Hodgkin lymphomas.

Author information

1
Division of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI. Electronic address: mehdi.hamadani@gmail.com.
2
Division of Hematology-Oncology, American University of Beirut Medical Center, Beirut, Lebanon.
3
Myeloma Institute for Research and Therapy, University of Arkansas for Medical Sciences, Little Rock, AR.
4
Hematology and Stem Cell Transplantation Section, Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN.
5
Department of Blood and Marrow Transplantation, H. Lee Moffitt Cancer Center and Research Institute and University of South Florida College of Medicine, Tampa, FL.

Abstract

T-cell non-Hodgkin lymphomas (NHLs) are a heterogeneous group of malignancies that represent 10%-15% of all NHLs. The prognosis of relapsed T-cell NHL is poor, especially for those relapsing after an autologous (auto-) or allogeneic (allo-) hematopoietic cell transplantation (HCT). Disease relapse post auto-HCT is best managed on a clinical trial. In the absence of an investigational protocol, the choice of salvage therapies should take into account patient performance status, eligibility for an allo-HCT, and surface CD30 expression. CD30-directed therapies or aggressive salvage regimens can be used as a bridge to allo-HCT in medically fit patients. In the elderly or more infirm patients, single-agent therapies could be offered, aiming at palliation. Similarly, relapse after an allo-HCT is not uncommon and is a real challenge. Reduction in ongoing immune suppression or donor lymphocyte infusion are often considered in this setting to augment graft-versus-lymphoma (GVL) effects and can occasionally provide durable disease control. Clinical trials designed to investigate novel therapeutic agents with immunomodulatory properties to augment GVL effects (eg, histone deacetylase [HDAC] inhibitors, proteasome inhibitor, lenalidomide) or targeted therapies (eg, aurora A kinase inhibitors, anaplastic lymphoma kinase [ALK] inhibitors) are sorely needed to improve the dismal outcomes of T-cell NHL relapsing after an allo-HCT.

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