Autologous stem cell transplantation (ASCT) has been seen to overcome resistance, allowing an increase in the dose of available drugs and radiotherapy. Initially used after first-line for relapsed or refractory non-Hodgkin's lymphomas (NHL), ASCT has since been used in more favourable clinical conditions such as partial remission (PR), first completeremission, and as front-line therapy following chemotherapy. High-dose chemotherapy and autologous stem-cell transplantation has now became the standard care for eligible patients with recurrent, chemosensitive aggressive NHL. Primary refractory patients and resistant relapse are not good indications and should be considered a group eligible for phase II studies. There may also be a role in patients with partially responsive disease. However new and larger randomised studies are needed to clarify this question. A challenge for lymphoma management is the evaluation of the role of high-dose therapy and ASCT as an initial treatment in aggressive NHL, identifying patients who will not be cured with standard therapy. A series of concurrent or retrospective analysis would indicate so-called "higher-risk patients", as defined by the IPI, as potential targets for intensified therapy. However, according to published data, the problem remains open to debate. Larger, randomised studies are necessary and welcome and this should be considered a high priority.
Autologous stem cell transplantation; non-Hodgkin's lymphomas