Allografting versus Autografting for Follicular Lymphoma: An Ongoing Conundrum.

Abstract

It has been more than 2 decades since the initial reports on autologous transplantation for follicular lymphoma [1,2]. These studies were paradigm changing because they provided the first evidence of a curative therapy in this chronically relapsing illness. However, autologous transplantation was effective in only a fraction of carefully selected patients with chemotherapy-sensitive disease. Relapse rates were high, possibly caused by infusion of occult lymphoma cells [3]. Therapy-related myelodysplastic syndrome/acute myeloid leukemia, mostly occurring in the first 5 years after transplant, emerged as a considerable problem, attributable to conditioning, to prior treatment, and possibly to stem cell mobilization method [4,5]. Allogeneic transplantation was soon found to have a very low incidence of disease recurrence but also a high early mortality [6]. Three prior studies have compared autologous and allogeneic transplantation with consistent conclusions: allogeneic transplantation has much higher treatment-related mortality, regardless of conditioning intensity, but lower rates of recurrence [7-9]. In this issue, Klyuchnikov et al. [10] address the same issue again, from a somewhat different angle: They include only patients with prior exposure to rituximab, only allo-transplants undergoing reduced-intensity conditioning, and limit their analysis to patients with follicular grades I and II disease. They find that allogeneic transplant recipients tend to have more advanced disease, die much more frequently from complications, and relapse less. Patients with high lactate dehydrogenase and poor