The choice of allogeneic or autologous hematopoietic transplantation for NHL.

Abstract

NHL constitutes the sixth most common malignancy diagnosed in the USA every year, accounting for approximately 24,400 deaths. Although a subset of patients can be cured with chemotherapy or radiation therapy, the outlook is generally poor for patients with refractory or recurrent disease. High-dose therapy supported by both autologous and allogeneic transplantation has been widely studied in this group of patients. Autologous transplantation may be considered standard therapy for patients with diffuse large-cell NHL in chemotherapy-sensitive relapse. Selected categories of patients with other histologic subtypes may also benefit from this strategy. Allogeneic transplantation using high-dose myeloablative conditioning regimen is an effective, yet hazardous approach. A GvL effect leads to a lower rate of disease recurrence than occurs with autologous transplants, but this benefit is offset by higher risk of treatment related mortality. The recent use of less toxic non-myeloablative conditioning regimens for allogeneic transplantation has reduced the risk of transplant-related mortality, allowing this approach even in older or medically infirm patients. Nonablative allogeneic transplants are a promising strategy, particularly for patients with indolent lymphoid malignancies.