Role of autologous bone marrow transplantation in non-Hodgkin's lymphoma.

Although the conventional therapy of patients with NHL has improved over the past 20 years, approximately 50% of the patients still are not cured of their disease with routine therapy. The use of high-dose chemoradiotherapy and ABMT has now been shown to salvage a portion of this patient population. Despite these advances, there are areas that need further research to improve the long-term disease-free survival. For example, relapses frequently occur in areas of previous disease sites. This may imply that the conditioning regimen was not adequate, or that tumor cells contaminating the infused hematopoietic product tracked to the site of previous disease. Further advances in the dose-intensity of conditioning regimens, or perhaps alternative hematopoietic stem cell sources such as purged bone marrow, allogeneic bone marrow, or autologous peripheral stem cell grafts, may improve these results. Other potential areas for development include the use of hematopoietic growth factors in an attempt to decrease the morbidity and mortality associated with transplant, and the use of ABMT as intensification therapy following conventional therapy in patients with intermediate or high-grade NHL with poor prognostic features. The exact role of high-dose therapy and ABMT for follicular low-grade NHL is not clear at this time and will require further analysis. It is hoped that continued efforts to improve the risks associated with high-dose therapy and ABMT, to identify the optimal regimens and rescue products for certain subtypes of NHL, and to identify earlier in the course of disease those patients who would benefit from ABMT will increase the percentage of long-term disease-free survivors with NHL.