Commentary on Abstract #1177

The relative clinical efficacy of autologous or allogeneic bone marrow transplantation (BMT) remains a controversial issue. In most series, outcomes with the two types of transplants have been comparable; relapse is more common with autologous BMT due to contamination of stem cells, whereas allogeneic BMT is associated with greater treatment-related mortality.

These results contrast with data presented by Khouri et al (abstract #1177) at ASH. They compared the outcome of 38 patients with low-grade NHL who underwent allogeneic BMT with that in 72 patients who had an autologous transplant. The allogeneic group was younger but had a higher incidence of refractory disease. The autologous group had received more extensive prior therapy.

Overall survival rates favored allogeneic over autologous transplantation (55% vs 35%), as did event-free survival rates (44% vs 15%). As expected, the relapse rate was significantly higher in the autologous group. No mortality data were provided. The differences between allogeneic and autologous BMT were most impressive in patients who had bone marrow involvement, those with a lower tumor burden, and those who had received less prior therapy.

Discrepancies among the various studies may relate to differences in histology or to other prognostic factors.