Autotransplants: now and in the future

Two points were raised in the meeting summary. One was the relative consistency of autotransplant results in lymphomas and solid tumors which appear to be about 20% 3-year disease-free survival in persons with advanced disease regardless of diagnosis. Why is this and what does it mean? Perhaps this is the limit of additional cures achievable by dose escalation; further escalations may not be more effective or may trade increased anticancer efficacy for toxicity. It is also essential to be certain that this seemingly improved outcome over conventional therapy is not the result of subject-selection or time-to-treatment biases and whether these persons are cured. The second point relates 'optimal' timing of autotransplants. Certainly, better overall results are achieved by selecting the 'best' subjects. However, prognosis factors for autotransplant outcome resemble those for chemotherapy. Therefore, a potential consequence of selecting the best subjects for autotransplants is to exclude precisely those persons most likely to benefit. Needed is a balance between improving autotransplant results and rescuing the greatest number of subjects. How to achieve this balance is presently uncertain. Presently, there is much enthusiasm for autotransplants; their use is expanding very rapidly. In some cancers and disease states autotransplants likely represent the most effective current therapy. However, this is not known to be so for most autotransplants. Controlled and/or randomized trials are now needed to evaluate efficacy in other settings. Hopefully, these studies will be performed soon.