الفهرس 
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Abstract
Non-Hodgkin lymphoma (NHL) is the seventh most common cancer diagnosed in the United States, with approximately 66000 new cases diagnosed in 2009.
In Egypt the incidence of NHLs is very high according to Middle East Cancer consortium (MECC), the NHLs age standardized incidence rates (ASRs) are (16.3/100.000 person). This very high incidence making NHLs the third most common cancer in Egyptian males and the second most common cancer in females, accounting for 10.9% of all cancer in Egypt diagnosed every year.
The 2008 WHO classification is the continuation of a successful international collaboration among pathologists, biologists and clinicians interested in the hematological malignancies.
NHL can be subdivided into indolent, aggressive, and highly aggressive histologic entities. The IPI is used for risk stratification. Patient classification by IPI into groups with low, low-intermediate, high-intermediate, and high risk can be applied in aggressive lymphoma and other histologies.
Indolent non-Hodgkin lymphomas (NHLs) are chemosensitive, slow growing, and characterized by a continuous pattern of relapse.
T-cell non-Hodgkin lymphomas (T-NHLs) encompass a heterogeneous group of high-risk diseases characterized by inferior response rates, remission durations, and survivals compared with their B-NHL counterparts.
Many chemotherapy regimens have been used for treatment but have not improved long term outcome, which depends on initial prognostic factors such as the Follicular Lymphoma International Prognostic Index (FLIPI), response to first-line therapy, and minimal residual disease.
The treatment for aggressive NHL has evolved over the past decades. For more than 25 years, the CHOP regimen (eight cycles of cyclophosphamide, doxorubicin, vincristine, and prednisone with a 3-week break) has been the standard of care for aggressive lymphomas.
Rituximab is a chimeric monoclonal antibody that is directed against CD20, a B-cell antigen expressed by normal B lymphocytes and also by approximately 85% of non-Hodgkin lymphoma. The combination of rituximab plus chemotherapy is now considered standard therapy for diffuse, large B-cell lymphoma (DLBCL) based on several trials that have consistently demonstrated improved complete response (CR), failure-free survival, and overall survival in older and younger immunocompetent patients with DLBCL who received rituximab plus chemotherapy compared with chemotherapy alone.
As an alternative to antibodies, nanoparticles that are targeted to single cell types have gained attention for their potential to provide selective delivery of therapeutic agents with reduced side effects.
Hematopoietic stem cells (HSCs) are characterized by the ability to self-renew and differentiate into all mature blood lineages.
Hematopoietic cell transplantation (HCT) is an effective treatment for malignant and nonmalignant diseases. Over the last 3 decades, advances in treatment and supportive care have translated into steady improvements in survival after allogeneic HSCT.
A balanced risk-benefit approach to hematopoietic cell transplantation (HCT) is the key for maximized chances of cure with acceptable quality of life for patients with advanced hematologic malignancies. When considering efficacy, high-intensity conditioning regimens could eradicate the underlying malignancy that was previously refractory to all other conventional therapeutics.
During the last 30 years, both the number of hematopoietic cell transplantations (HCTs) performed annually and the number of diseases for which HCT is therapeutically indicated have increased.
Allogeneic hematopoietic stem cell transplantation (HSCT) is an effective treatment for many hematologic malignancies due, in part, to the graft-versus-tumor (GVT) responses mediated by donor T cells in the graft. However, significant obstacles such as tumor relapse and graft-versus-host disease (GVHD) still limit the efficacy of this procedure.
Patients who relapse after achieving complete remission (CR) or never achieve CR of non-Hodgkin lymphoma (NHL) can rarely be cured with further chemotherapy. However, high-dose chemoradiotherapy with autologous bone marrow or peripheral blood stem-cell rescue is curative in some patients and is superior to conventional chemotherapy. Chemosensitivity of the lymphoma is one of the most important predictors of outcome with autologous transplantation.
Peripheral blood stem cells (PBSC) are the preferred source of stem cells for autologous transplantation because of the technical advantage and the shorter time to engraftment.
Recently, cord blood has been increasingly used in adults as a stem-cell source for allogeneic transplantation to treat hematologic malignancies. The overall results for CBT recipients were better than for BMT recipients in terms of graft-versus-host disease (GVHD), transplant-related mortality (TRM), and disease-free survival (DFS).
Chronic graft-versus-host disease (GVHD) is the most serious and common long-term complication of allogeneic HCT, occurring in 30% to 70% of adults and children surviving more than 100 days.
Cytomegalovirus (CMV) disease is a serious complication after allogeneic hematopoietic stem cell transplantation (allo-SCT), which is widely accepted as a curative therapy for advanced hematological malignancies including leukemia and malignant lymphoma.
At present, NHL is the second most frequent indication for autologous stem cell transplantation (ASCT) because ASCT has been found to provide an increasing number of patients having the disease with the best opportunity for cure under certain circumstances.
Randomized studies have established high-dose therapy and autologous stem cell transplant (HDT-ASCT) as the standard of care for relapsed and refractory diffuse large B cell lymphoma and Hodgkin’s lymphoma, whereas it remains controversial for other lymphoma subtypes.
HDT with allogeneic SCT has been investigated as an additional therapeutic option in younger patients. The efficacy of this strategy is enhanced by the supportive presence of a graft-versus-lymphoma (GVL) effect in chronic lymphoproliferative diseases.
Allogeneic hematopoietic cell transplantation (HCT) can produce a graft-versus-lymphoma (GVL) effect, resulting in disease regression even in chemotherapy-refractory patients.
On the basis of retrospective studies and at least one prospective randomized trial, autologous transplantation for patients with relapsed follicular lymphoma seems to extend disease-free and overall survival.
Comparisons of outcomes of myeloablative allogeneic HCT with those after autologous HCT found decreased relapse rates with allogeneic HCT but increased treatment-related fatalities.
Despite some evidence that ASCT might improve the outcome of MCL, in particular if used as part of first-line treatment, relapses continue to occur with the transplant strategies currently employed although follow up of published studies is limited.
The allogenic bone marrow transplantation remains the only therapeutic option with a curative potential in advanced-stage MCL.
Autologous hematopoietic cell transplantation (AHCT) has been offered to patients with PTCL as consolidation in first remission and for relapsed or refractory disease (REF).
The role of high-dose therapy and SCT in BL is limited. There are limited published data on the use of SCT as a component of first-line therapy.
Both autologous and allogeneic stem cell transplantation are viable treatment alternatives for the non-Hodgkin’s lymphomas. The decision as to which treatment to pursue is individualized based on the type of lymphoma, the stage of disease, and the general health of the patient. Importantly, allogeneic transplant requires a donor and finding a suitable donor takes time. Early referral to a transplant center is recommended for any patient being considered for an allogeneic transplant approach.