Disease relapse after autologous hematopoietic transplant (auto-HCT) remains the number one cause of post-transplant
therapy failure and mortality. The last decade has seen a proliferation of clinical studies looking at the prevention of post-auto-HCT
therapy failure with various maintenance strategies. The benefit of such
therapies is in turn dependent on disease histology and timing of
transplantation. Although high dose
therapy (HDT) provides durable responses in chemosensitive relapsed
diffuse large B-cell lymphoma (DLBCL), a sizable subset experiences disease relapse. Unfortunately, the addition of
rituximab as a post-auto-HCT maintenance strategy did not improve survival outcomes. The preliminary results with programmed death -1 (PD-1) Ab as post-auto maintenance in DLBCL is promising but requires randomized validation. In
follicular lymphoma, the 5- and 10-year PFS rates are ~60% and 31%, respectively. Although the addition of
rituximab improved PFS, there is no survival benefit, to date. Disease relapse after auto-HCT in
mantle cell lymphoma (MCL) is not uncommon.
Rituximab maintenance in this setting provides a PFS benefit. Given the poor prognosis of post-auto-HCT failures in MCL, maintenance can be considered on a case-by-case basis. In chemosensitive relapsed
Hodgkin lymphoma, addition of
brentuximab vedotin after auto-HCT improved 2-year PFS (65 vs 45%) and can be considered as an option for maintenance
therapy post auto-HCT, in select higher risk patients. Ongoing trials evaluating the efficacy of post-auto-HCT maintenance with novel agents (for example,
immunomodulators,
proteasome inhibitors,
PD-1 inhibitors,
Bruton's tyrosine kinase inhibitors and so on) will likely change the practice landscape for
lymphoma patients following HDT and auto-HCT.