Autologous bone marrow transplantation in patients relapsed one year after R-CHOP?

I have studied and worked with non-Hodgkin lymphoma (NHL) for at least 16 years in the Hospital das Clínicas and Instituto do Câncer do Estado de São Paulo of the Faculdade de Medicina da Universidade de São Paulo (FMUSP). Last year we attended 300 new patients with NHL and 49.5% (almost 150 patients) had diffuse large B-cell lymphoma (DLBCL). This is in agreement with the literature that describes DLBCL as the most common subtype of NHL (30% to 35%). Over the last four decades there has been a significant increase in the 5-year survival of patients with DLBCL. This is due to the development of anthracycline-based polychemotherapy regimens such as is used in the CHOP protocol and more recently, with the incorporation of immunotherapy with the monoclonal antibody anti-CD20 (rituximab) in the CHOP-regimen. However, 10% to 15% of DLBCL patients remain unable to acquire complete remission (CR) even in the rituximab era and 30% to 50% of the patients that acquire a first CR will relapse. As we have almost 150 patients per year with DLBCL in our service, we can assume that about 60 patients per year will have refractory or relapsed disease. Hence, we have a huge challenge every year with the main question being what is the best approach to offer to relapsed DLBCL patients? The unquestionable answer to this question is that patients have to be salvaged with a second line regimen and it is always possible to consolidate the patient with autologous stem cell transplantation (ASCT). In this article I will try to examine the level of evidence of this approach and to introduce the experience I acquired over these 16 years of NHL.