Allogeneic stem cell transplantation for the non-Hodgkin's lymphomas and Hodgkin's disease

Certain poor-prognosis patients with non-Hodgkin's lymphoma and Hodgkin's d isease. usually with recurrent and/or refractory disease, are rarely curabl e with standard chemoradiotherapy. Autologous hematopoietic stem cell trans plantation has been shown to result in improved long-term disease-free surv ival in some of these patients. Unfortunately a number of patients are not suitable for autologous transplantation due to a damaged stem cell pool inv olvement or other disease processes of the marrow. These patients may benef it from allogeneic stem cell transplantation. In addition to the therapeuti c effect of high-dose chemotherapy with or without total body irradiation. an immunologic [i.e. graft-versus-lymphoma (GVLym)] effect may be present i n some patients undergoing allogeneic transplantation, resulting in a lower relapse rate than autotransplants. However. allografts are almost always a ssociated with a higher non-relapse mortality due primarily to graft-versus -host disease (GVHD); unfortunately GVHD and GVLym are difficult to separat e. Thus, full exploitation of-this GVLym effect may require the modificatio n of commonly used conditioning regimens; if successful, these modification s may allow an additional decrement in the incidence of relapse without add itional morbidity. Also, when combined with lesser intensity conditioning. such may permit patients who otherwise would not be candidates for standard transplant regimens to be allografted. (C) 2000 Harcourt Publishers Ltd.