Autologous bone marrow transplantation in the treatment of malignant lymphoma and Hodgkin's disease.

High-dose chemotherapy, both with and without radiotherapy, was pioneered in the treatment of acute leukemia in relapse with allogeneic transplantation, exploiting the steep dose-response curve characteristic of some hematologic neoplasms. Extension to the malignant lymphomas was strengthened by early success in Burkitt's lymphoma and in syngeneic transplantation for lymphoma. The optimal regimen (BACT [carmustine, cytarabine, cyclophosphamide, 6-thioguanine]) and setting are still under investigation for the various grades of lymphomas. The early published experience demonstrated a low ultimate "cure" rate when transplantation was performed in advanced, bulky, and refractory disease. A survey of published reports up to 1986 showed only 16 of 112 long-term, disease-free survivors when autologous bone marrow transplantation (ABMT) was performed in refractory relapse as opposed to 33 of 53 for patients transplanted in second or subsequent remission or in first partial remission. Refractoriness to conventional-dose chemotherapy (no response or progressive disease) cannot be salvaged in the majority of cases. Bone marrow involvement complicates the use of ABMT and may require in vitro elimination with monoclonal antibodies/complement or cytotoxic chemicals. The Dana-Farber Cancer Institute experience shows that the former in vitro treatment does not inhibit bone marrow grafting. When selection criteria for ABMT are applied in drug-sensitive relapse, 50% to 60% long-term, disease-free survival may be expected. Definition of poor prognostic factors in large cell lymphoma may identify patients for ABMT as consolidation of first remission. The issue of marrow purging is unsettled at the present time.(ABSTRACT TRUNCATED AT 250 WORDS)