Evidence of a graft-versus-lymphoma effect associated with allogeneic bone
marrow transplantation
RJ Jones, RF Ambinder, S Piantadosi and GW Santos
Johns Hopkins Oncology Center, Johns Hopkins Medical Institutions,
Baltimore, MD 21205.
The existence of an immunologic antileukemia reaction associated with
allogeneic bone marrow transplantation (BMT) is well established. However,
a similar graft-versus-tumor effect against lymphomas has not been
demonstrated. We analyzed the results of BMT in 118 consecutive patients
with relapsed Hodgkin's disease or aggressive non-Hodgkin's lymphoma. The
38 patients less than 50 years of age with HLA-matched donors had allogenic
marrow transplants, and the other 80 patients received purged autologous
grafts. The median age was 26 years in both the allogeneic and the
autologous graft recipients. The patient's response to conventional salvage
therapy before transplant was the only factor that influenced the
event-free survival after BMT (P less than .001). Both the patient's
response to salvage therapy before BMT (P less than .001) and the type of
graft (P = .02) significantly influenced the probability of relapse after
BMT. The actuarial probability of relapse in patients who responded to
conventional salvage therapy before BMT was only 18% after allogenic BMT
compared with 46% after autologous BMT. However, the actuarial probability
of event-free survival at 4 years was the same, 47% versus 41%, for
patients with responsive lymphomas who received allogeneic and autologous
transplants, respectively (P = .8). The beneficial antitumor effect of
allogeneic BMT was offset by its higher transplant-related mortality (P =
.01), largely resulting from graft-versus-host disease. Allogeneic BMT
appears to induce a clinically significant graft-versus- lymphoma effect.
The magnitude of this effect is similar to that reported against leukemias.
Volume 77,
Issue 3,
pp. 649-653,
02/01/1991
Copyright © 1991 by The American Society of Hematology
