Non-Hodgkin lymphoma (NHL) constitutes a collection of lymphoproliferative disorders
with widely varying biological, histological, and clinical features. For the B cell
NHLs, great progress has been made due to the addition of monoclonal antibodies and,
more recently, other novel agents including B cell receptor signaling inhibitors,
immunomodulatory agents, and proteasome inhibitors. Autologous hematopoietic cell
transplantation (auto-HCT) offers the promise of cure or prolonged remission in some
NHL patients. For some patients, however, auto-HCT may never be a viable option, whereas
in others, the disease may progress despite auto-HCT. In those settings, allogeneic
HCT (allo-HCT) offers the potential for cure. Over the past 10 to 15 years, considerable
progress has been made in the implementation of allo-HCT, such that this approach
now is a highly effective therapy for patients up to (and even beyond) age 75 years.
Recent advances in conventional lymphoma therapy, peritransplantation supportive care,
patient selection, and donor selection (including the use of alternative hematopoietic
cell donors), has allowed broader application of allo-HCT to patients with NHL. As
a result, an ever-increasing number of NHL patients over age 60 to 65 years stand
to benefit from allo-HCT. In this review, we present data in support of the use of
allo-HCT for patients with diffuse large B cell lymphoma, follicular lymphoma, and
mantle cell lymphoma. These histologies account for a large majority of allo-HCTs
performed for patients over age 60 in the United States. Where possible, we highlight
available data in older patients. This body of literature strongly supports the concept
that allo-HCT should be offered to fit patients well beyond age 65 and, accordingly,
that this treatment should be covered by their insurance carriers.