Cytotherapy (2002) Vol. 4, No. 3, 205–215 205 © 2002 ISCT Autologous hematopoietic transplantation for low-grade lymphomas JG Gribben Department of Adult Oncology, Dana-Farber Cancer Institute, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA Correspondence to: John G Gribben, Department of Adult Oncology, Dana-Farber Cancer Institute, Department of Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA Background Autologous stem cell transplantation (SCT) has become the treatment of choice for patients with relapsed chemo-sensitive intermediate grade lymphoma, but its role in the treatment of low-grade lymphomas and in selected patients in first remission remains controversial. Methods A large number of clinical trials have evaluated the role autologous SCT in both low grade and intermediate grade non-Hodgkin’s lymphomas (NHL). These studies have attempted to evaluate the role of high dose therapy with stem cell support in comparison to more conven- tional chemotherapy approaches. Studies have also focused on methods to assess whether contaminating tumor cells are contained with the stem cell collection and whether this has impact on outcome. With an increased number of patients now long term survivors, additional studies are focusing on long term complications and in particular the emergence of secondary malignancies. Results Virtually all patients now receive peripheral blood stem cells rather than bone marrow as a source of stem cells. The role of purging of residual tumor cells remains controversial and no randomized trial has been published to date that could evaluate the clinical utility of cell manipulation to attempt to remove contaminating lymphoma cells. Secondary leukemia is emerging as a major source of long-term morbidity and mortality after autologous stem cell transplantation. Conclusion Autologous SCT is associated with improved outcome in patients with relapsed intermediate grade lymphoma and most likely prolongs disease free survival in patients with low grade NHL. Morbidity and mortality of the procedure is low and major efforts are being made to attempt to decrease the major causes of failure, which remain disease relapse and occurrence of secondary malignancies. Keywords Low-grade non-Hodgkin’s lymphoma, CLL, mantle-cell lymphoma, stem-cell transplantation. Role of SCT in low-grade lymphoid malignancies Although high-dose therapy (HDT) with stem-cell support has become the treatment of choice for patients with relapsed intermediate-grade lymphoma [1], the role of stem- cell therapy (SCT) in the management of patients with low-grade NHL remains more controversial. As shown in Table 1, there are many reasons why SCT has been used less frequently in patients with low-grade lymphoma. There has been reluctance to perform potentially lethal treatment procedures in diseases with relatively long natural histories, which tend to occur in more elderly patients. The very high incidence of BM infiltration in these diseases has made it difficult to use autologous stem-cells for rescue after HDT. Lastly, although the indolent lymphomas are characterized by initial chemotherapy responsiveness, by the time SCT is considered as a treatment option, many of these patients are heavily pre-treated and have acquired chemotherapy resis- tance and decreased BM reserve. However, the risk of unacceptable mortality is decreased by judicious patient selection and improvements in supportive care in transplan- tation, and increasing numbers of patients with advanced stage follicular lymphoma (FL), mantle-cell lymphoma (MCL) and CLL are now undergoing these procedures. Martin Dunitz Taylor&Francis healthsciences