ALLOGENEIC VERSUS AUTOLOGOUS BONE-MARROW TRANSPLANTATION FOR REFRACTORY AND RECURRENT LOW-GRADE NON-HODGKINS-LYMPHOMA

Patients with recurrent or refractory low-grade non-Hodgkin's lymphoma (NHL) are increasingly treated with myeloablative therapy and autolog ous stem cell transplantation. However, allogeneic bone marrow transpl antation (BMT) is only sporadically performed in such patients. Theref ore, we wish to compare treatment results of patients with recurrent o r refractory low-grade NHL who underwent allogeneic BMT with those who underwent autologous BMT in our center. Twenty-eight patients were st udied. The patients had received 2 to 5 lines of conventional chemothe rapy before the BMT procedure. Eighteen patients, all with chemotherap y-sensitive disease at the time of transplantation, underwent autologo us BMT and 10 patients, of whom 7 with chemotherapy-resistant disease at the time of transplantation, underwent allogeneic BMT, Furthermore, all allogeneic BMT patients had overt lymphoma infiltration of the BM at the time of transplantation. The conditioning regimen consisted of cyclophosphamide plus total body irradiation in all 28 patients. All allogeneic BMT patients achieved complete remission, 3 patients had a treatment-related death, and 7 patients are alive and disease-free wit h a median followup of 41 months. In contrast, none of the autologous BMT patients died of transplant-related complications. However, despit e the fact that all autologous BMT patients had chemotherapy-sensitive disease and partial remission was converted to complete remission by the BMT procedure in 67% of them, only 3 of 18 patients are alive and disease-free. The probability of relapse or disease-progression among autogeneic BMT patients was 0% compared with 83% for autologous BMT pa tients (P = .002). Progression-free survival rates 2 years after BMT w ere 68% for allogeneic BMT patients and 22% for autologous PMT patient s (P = .049). Although the numbers of patients are small, this study s uggests that allogeneic BMT offers a better chance for cure than autol ogous PMT for patients with poor-prognosis low-grade lymphoma, and the difference in relapse or disease progression is strongly suggestive f or the existence of a graft-versus-low-grade lymphoma effect. (C) 1997 by the American Society of Hematology.