ALLOGENEIC BONE-MARROW TRANSPLANT IS NOT BETTER THAN AUTOLOGOUS TRANSPLANT FOR PATIENTS WITH RELAPSED HODGKINS-DISEASE

Purpose: To compare the results achieved with myeloablative therapy fo llowed by either allogeneic bone marrow transplantation (alloBMT) or a utologous bone marrow transplantation (ABMT) for patients with Hodgkin 's disease (HD). Patients and Methods: Of more than 1,200 patients wit h HD reported to the European Bone Marrow Transplantation (EBMT) regis try, 49 underwent alloBMT. Of these, 45 with sufficient data were matc hed to 45 patients who underwent ABMT. The matching criteria were sex, age at time of transplantation, stage of the disease at diagnosis, bo ne marrow involvement at diagnosis and at transplantation, year of tra nsplantation, disease status at time of transplantation, time from dia gnosis to transplantation, and conditioning regimen with or without to tal-body irradiation (TBI). Results: The 4-year actuarial probabilitie s of survival, progression-free survival (PFS), relapse, and non-relap se mortality were 25%, 15%, 61%, and 48% and 37%, 24%, 61%, and 27% af ter alloBMT and ABMT, respectively. The toxic death rate at 4 years wa s significantly higher for alloBMT patients (P = .04). For patients wi th sensitive disease at the rime of transplantation, the 4-year actuar ial probability of survival wets 30% after alloBMT and 64% after ABMT (P = .007). This difference is mainly due to a higher transplant-relat ed mortality rate after alloBMT (65% v 12%, P = .005). Acute graft-ver sus-host disease (aGVHD) greater than or equal to grade II was associa ted with a significantly lower risk of relapse, but also with a lower overall survival (OS) rate. Conclusion: Based on this study, alloBMT f rom a human leukocyte antigen (HLA)-identical sibling donor does not a ppear to offer any advantage when compared with ABMT. A graft-versus-H odgkin effect is associated with greater than or equal to grade II aGV HD, but its positive effect on relapse is largely offset by its toxici ty. In most circumstances, alloBMT cannot be recommended for patients with HD. (C) l996 by American Society of Clinical Oncology.