Peggs et al. (2005) Clinical evidence of a graft-versus-Hodgkin's lymphoma effect after reduced intensity allogeneic transplantation. Lancet 365: 1934–1941

There has been limited evidence for a therapeutic GVT EFFECT in patients with multiply relapsed Hodgkin's lymphoma. Peggs and colleagues therefore investigated the GVT effect of reduced-intensity allogeneic transplantation.

Between October 1997 and August 2003, 49 patients from seven centers in the UK, who had multiply relapsed Hodgkin's lymphoma and who had previously had autologous stem-cell transplantation, participated in this study. All patients underwent reduced-intensity allogeneic transplantation; 31 of these patients had human leukocyte antigen-matched donors to whom they were related, and 18 had unrelated donors. Primary endpoints included toxic effects, non-relapse-related mortality, incidence of graft-versus-host (GVH) disease and toxic effects of adjuvant donor-lymphocyte infusion.

All patients sustained engraftment. Eight patients developed acute GVH disease and seven patients chronic GVH disease before donor lymphocyte infusion. Non-relapse-related mortality was 16.3% overall, and at 730 days median follow-up was found to be significantly higher in those with unrelated donors (34.1%) than in those with related donors (7.2%) at . Four-year overall survival in all patients was 55.7%.

The authors conclude from these results that patients receiving reduced-intensity allogeneic hemopoietic stem-cell transplantation from either related or unrelated donors demonstrated durable response, associated with reduced non-relapse-related mortality and fewer toxic effects compared with conventional transplantation protocols. The authors call for randomized studies to confirm these findings and to rule out selection bias.