Autologous stem cell transplantation in treatment of aggressive non-Hodgkin's lymphoma

There is no doubt that autologous stem cell transplantation is useful for patients with relapsed aggressive non-Hodgkin's lymphoma if they are responsive to the chemotherapy given before the transplantation. A small subset of patients with primary refractory disease still profits from this high dose chemotherapy regimen, but only if chemosensitive and if presenting with favorable risk factors at the moment of transplant eligibility. Autologous stem cell transplantation as upfront first line therapy for patients with aggressive non-Hodgkin's lymphoma does not contribute to a better outcome, most certainly not if it concerns patients with a favorable risk profile. There is still some doubt whether there is any place for autologous stem cell transplantation as first line therapy for patients with all unfavorable risk profile. Most randomized studies do not show an advantage, but more data are needed to definitely assess the place for this therapy option.