Update of results of autologous bone marrow transplantation in lymphoma

A substantial proportion of patients with Hodgkin's disease and non-Hodgkin's lymphoma will fail to achieve a complete remission with initial chemotherapy or will relapse after attaining a complete remission. The results of conventional salvage chemotherapy regimens for these patients have been disappointing. This has led to the use of high-dose therapy regimens which can be administered with the use of hematopoietic rescue (bone marrow transplantation). The use of bone marrow transplantation for patients with relapsed and refractory lymphoma has increased rapidly. Data from the North American Autologous Bone Marrow Transplant Registry indicate that approximately 40% of autologous bone marrow transplants are being performed for patients with lymphoma. Several large series of transplantation for Hodgkin's disease and non-Hodgkin's lymphoma have been published in the last two years. The results of these series vary widely due to differences in patient selection and pre-transplant prognostic factors. Differences in supportive care and preparative regimens prior to transplant may also account for the wide range of outcomes reported after transplantation. Although these differences make it impossible to compare results of one series with another, it is clear that a significant proportion of patients can achieve long term disease free survival following high dose therapy with marrow transplantation. It is also important, however, to note that this form of therapy can be associated with substantial morbidity and mortality. Transplant-related mortality exceeds 20% in some series. However, greater experience, better patient selection, and advances in supportive care, such as hematopoietic growth factors, are allowing many institutions to perform transplantation with mortality rates under 5%.