Allogeneic Versus Autologous Bone Marrow Transplantation for Refractory and Recurrent Low-Grade Non-Hodgkin's Lymphoma: Updated Results of the Utrecht Experience

This study was conducted to compare the results of myeloablative therapy followed either by autologous stem cell transplantation (SCT) or allogeneic SCT for poor-risk low-grade non-Hodgkin's lymphoma. Eighteen patients received autologous SCT and 15 patients received allogeneic SCT. All autologous patients had chemosensitive disease while this was the case in only 8 allogeneic patients. Besides, 14 of 15 allogeneic patients still had overt lymphoma infiltration of the marrow, when SCT took place. Despite these unfavorable characteristics, all allogeneic patients achieved complete remission (CR) with this procedure and, until now, none has relapsed. In contrast, 14 of 18 autologous patients achieved CR with SCT but 11 (79%) relapsed. Four allogeneic patients (27%) had a treatment-related death, whereas this did not occur with autologous SCT. The 3-year probabilities of relapse, overall survival, and event-free survival were 0%, 70% (95% CI, 38-87%), and 70% (95% CI, 38-87%) respectively for allogeneic SCT and 78% (95% CI, 57-93%), 33% (95% CI, 13-54%), and 22% (95% CI, 7-43%) respectively for autologous SCT. The differences in relapse and event-free survival were highly significant, p = 0.0002 and p= 0.015, respectively. These data show that allogeneic SCT leads to prolonged disease-free survival in patients with advanced poor-risk low-grade lymphoma which rarely occurs after autologous SCT. There is substantial evidence for a graft-versus-low-grade lymphoma effect.