American Journal of Hematology zyx 50:116-123 (1995) Autologous Bone Marrrow Transplantation Versus Chemotherapy in RelapsecURefractory Non-Hodgkin’s Lymphoma: Estimates of Long-Term Survival From the Recent Literature Kenneth R. Meehan, Robert S. Pritchard, Joshua W. Leichter, Benjamin Littenberg, and H. Gilbert Welch Department of Veterans Affairs Medical Center, White River Junction, Vermont (K.R.M., R.S.P., H.G.W.); Sections of Hematology/ Oncology (K.R.M., R.S.P.) and General Internal Medicine (J.W.L., B.L., H.G.W.), Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire Long-term survival following chemotherapy or autologous bone marrow transplantation in adults with relapsed/refractory non-Hodgkin’s lymphoma was evaluated. English lan- guage articles published from January 1, 1988 to September 1, 1993 were obtained from a broad-based MEDLINE search retrieving 3,854 citations regarding therapy for lymphomas. Citations were evaluated using both computer-based evaluation and manual review. Articles were included if they addressedthe diseaseof interest (non-Hodgkin’slymphoma, Working Formulation D-H), the population of interest (adults with either relapsed or refractory disease), and the therapies of interest (chemotherapy or autologous bone marrow transplantation). Articles were excluded if they did not provide convincing infor- mation on long-termsurvival (as evidenced by either survival analysis or individual patient data) or if they reported a small number of patients (N < 15). No randomized trials of the zyxwvut two therapies were found. Nine case series were found reporting on 444 eligible patients receiving chemotherapy; eight were found reporting on 256 patients undergoing autologousmarrow transplantation.After weighting by sample size, the mean 3-year survival rate was 25% (95% CI, 20-30%) following chemotherapy and 40% (95% CI, 33-47%) following marrow transplantation. The reporting of potentially relevant prognostic factors was inconsistent among articles. Despite our comprehensive synthesis and evaluation of currently available data, the survival advantage of marrow transplantation in relapsedlrefractory non-Hodgkin’s lymphoma that we report must be viewed as tentative, given the limitations of the case series data. In addition, establishing the comparability of patients treated with these therapies is made more difficult by the inconsistent reporting of potentially relevant prognostic factors. The results of an international randomizedtrial of these two therapies is forthcoming and may address some of these shortcomings. Key words: Non-Hodgkin’s lymphoma, autologsus bone marrow transplantations, long- term survival zyxwvuts o 1995 Wiley-Liss, Inc? INTRODUCTION zyxwvutsrq The non-Hodgkin’s lymphomas (NHL) are the most common hematologic malignancy in the United States, with 45,000 new cases expected in 1994 [ 11. Furthermore, the National Cancer Institute reports a doubling of both incidence and mortality rates over the past three decades [2]. Although there are indolent forms of NHL, many are aggressive and, if left untreated, ultimately cause death. This combination of high prevalence, rising incidence @ 1995 Wiley-LiSS, Inc. *This article is a US Government work and, as such, is in the public domain in the United States and an often fatal natural history emphasizes the impor- tance of evaluating the therapeutic interventions used to treat these disorders. Received for publication February 2, 1995; accepted May 10, 1995. Address reprint request to Dr. Welch, VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009.