When is it appropriate to use stem cell transplant for newly diagnosed DLBCL patients? What are the eligibility criteria?

When is it appropriate to use stem cell transplant for newly diagnosed DLBCL patients? What are the eligibility criteria?

Stem cell transplant sounds a little scary. You hear the word transplant. There's two types of stem cell transplant. Again this is just when you are getting blood stem cells. And one type is when you get the blood stem cells from somebody else. It could be a relative or it could be a stranger. We call that allogeneic stem cell transplant. That's actually extremely rare in DLBCL. More common in some other types of lymphomas. And then the more common type, we talk about is autologous stem cell transplant. You get stem cells from your cells.

And how does that work?

It's not that complicated. We get stem cells nowadays. We don't actually in the old days we'd have to poke people in their bone marrow to get the stem cells. We don't do that. Almost ever now. We get the stem cells from the blood. Not too complicated. You kind of give blood instead of for two minutes. You give blood for a few hours and then collect all of the stem cells that are needed. And they put those stem cells literally in the freezer. And why do we do that? It's because stem cells don't like to get too much chemotherapy. So once they're in the freezer and people can get a big whopping dose of chemotherapy, and if the chemo was working pretty well to fight lymphoma, then a whopping dose can sometimes get rid of all the lymphoma.

And because stem cells wouldn't like to be treated with all that chemotherapy, they're protected because they're in the freezer. You get one kind of it's really just about one a few days, whopping dose of chemotherapy. And then they give you the stem cells back right afterwards so that they were protected from from those side effects. And then it takes weeks for those stem cells to make all of the new blood cells, white blood cells, red blood cells, and during that time, during those weeks, people are have very low immune systems and they have to be in the hospital for weeks at a time.

So as you can hear, this is a big deal therapy, this treatment stem cell transplant had a big role not for first treatment of DLBCL, but for sort of second treatment plan B, if the first treatment wasn't working well enough, it had a big role as a second treatment for DLBCL. But actually its role has diminished hugely in the past 2 or 3 years because we've developed newer immunotherapies. Again, not as part of plan A, the first line therapy, but as part of plan B and those immunotherapies. And the one example is called CAR-T cells have been more effective than that still a stem cell transplant and also gentler overall much easier. People get hospitalized for a little bit, but not for as long as they were getting hospitalized for those transplants.

So transplant still has a role, but its role is less than it used to be because we're getting newer, better therapies, so frequently. And all of those that I mentioned just there are really not for front line treatment of DLBCL, but for second line treatment, sometimes third line treatment of DLBCL.