Stem-cell transplantation for indolent lymphoma.

Stem-cell transplantation (SCT) has become the treatment of choice for patients with relapsed aggressive non-Hodgkin's lymphoma (NHL). The role of SCT in the management of patients with low-grade NHL remains controversial, although increasing numbers of patients with advanced-stage follicular lymphoma, mantle-cell lymphoma, and chronic lymphocytic leukemia (CLL) are now undergoing SCT. There is increasing concern regarding toxicity of autologous SCT, especially the long-term risk of development of myelodysplastic syndrome, which is higher than was expected. This has led to renewed interest in the role of allogeneic SCT for patients with NHL. A major advantage of allogeneic SCT is the potential for exploiting a graft-versus-lymphoma effect, and many studies under way are exploring the possibility of manipulating donor cells and the host to maximize T-cell responsiveness against lymphoma.