AUTOLOGOUS BONE-MARROW TRANSPLANTATION VERSUS CHEMOTHERAPY IN RELAPSED REFRACTORY NON-HODGKINS-LYMPHOMA - ESTIMATES OF LONG-TERM SURVIVAL FROM THE RECENT LITERATURE

Long-term survival following chemotherapy or autologous bone marrow tr ansplantation in adults with relapsed/refractory non-Hodgkin's lymphom a was evaluated. English language articles published from January 1, 1 988 to September 1, 1993 were obtained from a broad-based MEDLINE sear ch retrieving 3,854 citations regarding therapy for lymphomas. Citatio ns were evaluated using both computer-based evaluation and manual revi ew, Articles were included if they addressed the disease of interest ( non-Hodgkin's lymphoma, Working Formulation D-H), the population of in terest (adults with either relapsed or refractory disease), and the th erapies of interest (chemotherapy or autologous bone marrow transplant ation). Articles were excluded if they did not provide convincing info rmation on long-term survival (as evidenced by either survival analysi s or individual patient data) or if they reported a small number of pa tients (N < 15). No randomized trials of the two therapies were found. Nine case series were found reporting on 444 eligible patients receiv ing chemotherapy; eight were found reporting on 256 patients undergoin g autologous marrow transplantation. After weighting by sample size, t he mean 3-year survival rate was 25% (95% CI, 23-30%) following chemot herapy and 40% (95% CI, 33-47%) following marrow transplantation. The reporting of potentially relevant prognostic factors was inconsistent among articles. Despite our comprehensive synthesis and evaluation of currently available data, the survival advantage of marrow transplanta tion in relapsed/refractory non-Hodgkin's lymphoma that we report must be viewed as tentative, given the limitations of the case series data . In addition, establishing the comparability of patients treated with these therapies is made more difficult by the inconsistent reporting of potentially relevant prognostic factors. The results of an internat ional randomized trial of these two therapies is forthcoming and may a ddress some of these shortcomings. (C) 1995 Wiley-Liss, Inc.