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Abstract

Objectives: The choice of whether to use bone marrow or peripheral blood in autologous transplantation remains controversial. Posttransplant relapse and long-term survival are critical issues. Materials and Methods: Studies that compared bone marrow transplant versus peripheral blood stem cell transplant in lymphoma patients were searched. Our search resulted in 15 studies. Results: Pooled data showed contradictory results with no conclusive differences in overall survival (for randomized controlled trials vs nonrandomized controlled trials: hazard ratio = 0.69 vs 1.17; 95% confidence interval, 0.44-1.10 vs 0.90-1.51; and P = .12 vs P = .25), progression-free survival (for randomized controlled trials vs nonrandomized controlled trials: hazard ratio = 0.89 vs 1.14; 95% confidence interval, 0.57-1.38 vs 0.82-1.58; and P = .60 vs P = .43), and relapse rates. However, we observed an overall trend toward lower relapse rate after bone marrow transplant. Lower relapse rate was likely associated with better progression-free survival (P = .052), and lower transplant-related mortality was associated with better overall survival (P = .043). Conclusions: Autologous bone marrow transplant with mobilization should be reconsidered for lymphoma patients to reduce recurrence and improve quality of life. More powered randomized controlled trials are warranted to update our findings. Key words: Autologous transplantation, Bone marrow transplant, Hematopoietic stem cells IntroductionHigh-dose chemotherapy followed by autologous hematopoietic stem cell transplant (auto-HSCT or ASCT) has been a standard treatment modality for refractory or relapsed non-Hodgkin lymphoma (NHL) and Hodgkin disease. Early consolidative transplant improves the prognosis of patients with high-risk aggressive lymphoma who gain little benefit from conventional regimens alone. Autologous bone marrow and peripheral blood progenitor cells permit the use of significantly intensified chemotherapy or radiotherapy irrespective of fatal myelosuppression or hematologic toxicity. As a first-line treatment, high-dose chemotherapy plus ASCT substantially reduces the bone marrow tumor load, resulting in a high rate of complete response, but late relapses are common. Bone marrow transplant (BMT), which contains a number of different stem cell populations, including hematopoietic stem cells, mesenchymal stem cells, endothelial progenitor cells, and fibroblasts, may have a protective effect. Peripheral blood progenitor cells have become more popular due to their faster trilineage engraftment or because NHL usually involves the bone marrow. However, whether bone marrow or mobilized peripheral blood has more tumor cell contamination or greater clonogenic potential is unclear because tumor cells can also be mobilized to the peripheral blood. Although "solid tumors" like lymphoma are distinct from leukemia or other blood cancers, most systematic reviews and meta-analyses on this topic have taken all hematologic malignancies into account. To further investigate whether ...