High-dose therapy with stem-cell transplantation in the malignant lymphomas

High-dose therapy with hematopoietic progenitor-cell transplantation plays a key role in the treatment of Hodgkin's disease and the non-Hodgkin's lymp homas. First and foremost, transplantation is used as a salvage treatment f or those who relapse or do not achieve a complete remission with first-line chemotherapy, Carefully selected patients with poor prognostic features ma y benefit from the incorporation of high-dose therapy and transplant into t heir initial treatment programs. Despite a myriad of trials, many pivotal q uestions regarding the appropriate application of high-dose therapy with tr ansplantation to the lymphoid malignancies remain unsettled, including the role of allogeneic transplantation and the optimal timing of transplant for patients with poor prognostic indicators. Phase III studies are required t o address these issues; these trials will demand the active commitment of c oncerned transplanters and referring hematologists and oncologists. Althoug h autologous transplantation has been the preferred approach for the majori ty of patient subgroups, new approaches to allogeneic transplantation that have diminished toxicity may pave the way for a greater role for allogeneic grafting in the lymphoid diseases.