Comparisons Of Allo Sct Versus Auto

A number of investigations have reported trials comparing alio SCT to auto SCT for intermediate- and high-grade as well as low-grade NHL (Tables 65.6 and 65.7). Most of these studies were retrospective comparisons, often using observational databases from groups such as the IBMTR/ABMTR and the EBMTR. The reports often do not provide intricate detail regarding specific patients outcome. In several instances, the investigators reported the data using case-matched controls, and indicated hazard ratios for measures of patient outcome. In the case of intermediate- and high-grade NHL, Bierman and associates10 recently published a combined IBMTR/EBMTR analysis involving more than 3000 NHL patients receiving stem cell transplants. A total of 2018 patients received unpurged autografts while 376 patients were given purged autografts. Further, 774 patients received T-cell replete allografts and 119 allografts that were T-cell depleted. These groups were compared to 89 syngeneic grafts. These data from this observational database analysis failed to demonstrate a GvL effect. Recipients of unpurged auto SCT, however, had a fivefold increase risk of relapse compared to the syngeneic group; further, unpurged auto SCT patients had a twofold increased relapse rate compared to purged graft recipients. In the case of low-grade NHL patients, this finding was associated with an improved overall and disease-free survival. This information provides indirect evidence that autologous tumor contamination may contribute to NHL relapse, an advantage possessed by use of an allograft.

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