Intensive therapies in follicular non-Hodgkin lymphomas.

At diagnosis, approximately 80% of patients with follicular lymphoma (FL) have disseminated disease with one or more extranodal localizations (Ann Arbor stage IV), mostly corresponding to bone marrow (BM) involvement. Conventional chemotherapy is not curative nor does it substantially modify the natural course of the disease. Most patients with disseminated FL ultimately die from the disease, with a median survival time of 8 to 10 years.1 Innovative therapies have to be proposed to these patients. Some form of intensive therapy—for example, high-dose chemotherapy (HDT) or chemoradiotherapy followed by autologous or allogeneic hematopoietic stem cell transplantation—is an option. Recently, the autologous stem cell transplantation (ASCT) procedure has become easier and cheaper, and it has a mortality rate of below 5% and manageable morbidity. It could therefore be considered for patients with FL if it could be shown to improve survival. Allogeneic stem cell transplantation is another innovative approach, adding a graft-versus-lymphoma (GvL) effect. However, the high mortality rate of the procedure limits its indications. Nonmyeloablative allogeneic transplantation could increase the indications by decreasing the transplantationrelated mortality (TRM).