ALLOGENEIC BONE-MARROW TRANSPLANTATION FOR RELAPSED AND REFRACTORY HODGKINS-DISEASE AND NON-HODGKINS-LYMPHOMA

The relative benefit of allogeneic bone marrow transplantation (alloBM T) vs autologous BMT (autoBMT) for patients with relapsed or refractor y Hodgkin's disease (HD) or non-Hodgkin's lymphoma (NHL) remains uncer tain, Toxicity from graft-versus-host disease (GVHD) may diminish the potential benefits both of graft-versus-tumor activity and of receivin g uncontaminated donor marrow stem cells, From 1987 to 1995, 27 adults (ages 18-60 years; median 36) underwent alloBMT for lymphoma after fa ilure of standard chemotherapy, Twenty-one had NHL and sh had HD (nodu lar sclerosis), Thirteen patients had primary refractory disease or ch emotherapy-resistant relapses; two of these had relapsed after autoBMT . Three patients had untested relapses (one of them had relapsed after autoBMT), and 11 had chemotherapy-sensitive relapses. Twenty-four rec eived HLA-matched bone marrow from a sibling (one twin); three receive d haploidentical marrow cells, Nine (33%) died from lymphoma, Eleven ( 41%) died of treatment-related causes, Opportunistic infections were a substantial problem leading to eight of these deaths (30%). Six patie nts (22%) survive free of lymphoma 17-70 months post-BMT (median, 56 m onths); four had had sensitive relapses, one had had a resistant relap se, and one had had nontested relapse, Three have chronic GVHD (limite d in one; extensive in two), One HD patient who had relapsed after aut oBMT remains in remission 19 months after alloBMT. No therapy-related myelodysplasia has been observed, We conclude that alloBMT has substan tial morbidity in heavily pretreated lymphoma patients due to acute to xicity, infections and GVHD. However, 22% of our KD/NHL patients have had long-term disease-free survival.