Appropriate timing of hematopoietic cell transplantation (HCT) is critical to favorable outcomes. With some exceptions, transplanting earlier in the disease course generally leads to better outcomes.
The National Marrow Donor Program® (NMDP), which operates Be The Match®, and its research arm, the Center for International Blood and Marrow Transplant Research® (CIBMTR), collect and study data to learn how to improve patient outcomes.
On this page is comprehensive, disease-specific information on optimal transplant timing for both allogeneic transplants (related and unrelated) and autologous transplants.
Acute lymphoblastic leukemia (ALL)
Clinical studies and data collected by the CIBMTR have shown higher survival rates for adult ALL patients and pediatric patients with an HLA-identical sibling donor when allogeneic transplantation is performed earlier in the disease course (Figures 1, 2). [1-4]
Figure 1.
Probability of Survival after HLA-Identical Sibling Transplants for ALL, Age <20 Years, 2000-2009, by disease status. (CIBMTR data)
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Figure 2.
Probability of Survival after HLA-Identical Sibling Transplants for ALL, Age ≥20 Years, 2000-2009, by disease status. (CIBMTR data)
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For patients receiving unrelated donor marrow transplants, NMDP data show that for adult patients, five-year survival is significantly increased in patients transplanted in CR1 compared to patients in CR2 or with advanced disease, and significantly increased in patients transplanted in CR2 compared to patients with advanced disease (log-rank p-value <0.001) (Figure 3).
Figure 3.
ALL: Survival of adult marrow transplant patients, unrelated donor transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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In unrelated donor marrow transplants facilitated by the NMDP, 5-year survival for pediatric patients is significantly increased for patients in CR1 (61%) and CR2 (52%) compared to patients with advanced disease (35%) (log-rank p-value <0.001) (Figure 4).
Figure 4.
ALL: Survival of pediatric marrow transplant patients, unrelated donor transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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See further explanation of Figures 3 and 4 with downloadable PowerPoint® slides.
See the Recommended Timing for Transplant Consultation for recommendations for both adult and pediatric ALL patients. These recommendations are based on the evidence-based reviews on the role of HCT in both pediatric and adult ALL, published by the American Society for Blood and Marrow Transplantation (ASBMT). [5,6]
Acute myelogenous leukemia (AML)
Allogeneic transplant following myeloablative conditioning is currently considered the most effective anti-leukemic treatment option for adults with acute myelogenous leukemia (AML) in remission. For patients with high-risk AML, most centers plan allogeneic transplants at an early phase in the treatment plan because of the patients' high risk of early relapse. [7]
For adults receiving unrelated donor marrow transplants, NMDP data show survival is significantly increased for transplants in CR1 or CR2 compared to transplants for patients with advanced disease (log-rank p-value <0.001) (Figure 5).
For patients with an HLA-identical sibling donor, CIBMTR data show that the highest survival is obtained for allogeneic transplant in early disease stage (Figure 6).
CIBMTR data also show that survival is significantly higher after autologous transplantation for AML in early and intermediate disease stage than in advanced stage (Figure 7).
Figure 5.
AML: Survival of adult marrow transplant patients, unrelated donor transplants facilitated by the NMDP by disease stage, 2000-2009. (NMDP data)
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Figure 6.
Probability of Survival after HLA-Identical Sibling Transplants for AML, 2000-2009, by disease status. (CIBMTR data)
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Figure 7.
Probability of Survival after Autotransplants for AML, 2000-2009, by disease status. (CIBMTR data)
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For pediatric patients with an unrelated marrow donor, NMDP data show 5-year survival is significantly increased for patients transplanted in CR2 compared to patients with CR1 or advanced disease, and significantly increased for patients in CR1 compared to patients with advanced disease (log-rank p-value <0.001) (Figure 8).
However, a greater percent of patients transplanted in CR1 had poor-risk cytogenetics compared to patients transplanted in CR2. Unrelated transplant for AML in CR1 is indicated if the patient has poor-risk cytogenetics at diagnosis or induction failure.
Figure 8.
AML: Survival of pediatric marrow transplant patients, unrelated donor transplants facilitated by the NMDP by disease stage, 2000-2009. (NMDP data)
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See further explanation of Figures 5 and 8 with downloadable PowerPoint® slides.
See the Recommended Timing for Transplant Consultation for recommendations for both adult and pediatric AML patients. These recommendations are based on the evidence-based reviews on the role of HCT in both pediatric and adult AML, published by the ASBMT. [8,9]
Chronic myelogenous leukemia (CML)
Although allogeneic transplant is the only treatment with the potential for sustained, long-term remission in CML, the effectiveness of imatinib mesylate has made treatment decisions more complex for many patients with CML.
Resistance to imatinib — most commonly through a Bcr-Abl mutation — is approximately 4% per year in patients receiving the drug in early chronic phase, with higher rates for patients in advanced stages. For this reason, allogeneic transplantation remains an important salvage option for patients who develop imatinib resistance. [10]
For CML patients treated with allogeneic transplant, studies and CIBMTR data prior to the use of imatinib have shown that patients' likelihood of survival is significantly better when transplants are performed in chronic phase (Figure 9). [11,12]
NMDP data for patients with unrelated marrow donors show five-year survival is significantly increased in patients transplanted in first chronic phase (log-rank p-value <0.001) (Figure 10).
For nearly all patients, front-line treatment with imatinib followed by assessment of cytogenetic response every 3 to 6 months will determine if and when transplant is indicated. Patients recommended to proceed to transplant include those resistant to or with an incomplete cytogenetic response to imatinib. [13,14]
The graft-versus-leukemia effect is particularly pronounced in CML, and so reduced-intensity conditioning followed by allogeneic transplantation may be an acceptable treatment for many CML patients. [15,16]
See the Recommended Timing for Transplant Consultation for details on transplant recommendations for CML patients.
Figure 9.
Probability of Survival after Transplants for CML, 1998-2009, by disease status and transplant year. (CIBMTR data)
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Figure 10.
CML: Survival of adult marrow transplant patients, unrelated donor transplants facilitated by the NMDP, by disease stage, 2000-2009. (NMDP data)
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See further explanation of Figure 10 with downloadable PowerPoint® slides.
Myelodysplastic syndromes (MDS)
Disease-free survival after allogeneic HCT for MDS is correlated with patient age, MDS subtype, chromosomal abnormalities, and International Prognostic Scoring System (IPSS) risk groups. [17]
A decision analysis based on HLA-identical sibling donor transplants performed 1990-1999 and registered with the CIBTMR or performed at the Fred Hutchinson Cancer Research Center found that:
- For patients with low and intermediate-1 risk IPSS scores, a higher life expectancy was associated with transplant that was delayed but performed prior to development of AML. This was true particularly for adult patients younger than 40.
- For patients with intermediate-2 and high-risk IPSS scores, a higher life expectancy was associated with transplant performed at diagnosis [18]
CIBMTR data for patients with HLA-identical sibling donors show a higher likelihood of survival for transplants for patients transplanted in early disease stages for both related and unrelated donors (Figure 11).
Figure 11.
Probability of Survival after Allotransplants for MDS, 2000-2009, by disease status and donor type. (CIBMTR data)
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Figure 12.
MDS: Survival of adult marrow transplant patients by WHO disease classification, unrelated donor transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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Figure 13.
MDS: Survival of adult marrow and PBSC transplant patients by preparative regimen, unrelated donor transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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See further explanation of Figures 12 and 13 with downloadable PowerPoint® slides.
See the Recommended Timing for Transplant Consultation for details on transplant recommendations for MDS patients. These recommendations are based on an evidence-based review on the role of HCT in MDS, published by the ASBMT in 2009. [19]
Multiple myeloma
Although autologous transplantation is currently the standard of care for multiple myeloma, there has been renewed interest in allogeneic HCT in these patients due to the development of reduced-intensity or non-myeloablative conditioning and the concurrent reduction in immediate transplant-related mortality. [20]
A multi-center study published in 2005 of 229 patients (median age 52 years) undergoing non-myeloablative HCT for multiple myeloma found a three-year overall survival of 41% and a progression-free survival of 21%. [21]
Although timing of autologous transplant does not have a significant impact on overall survival, transplant as de novo treatment is preferred over salvage therapy because it may prolong time in remission and avoid the risk of myelodysplasia from conventional alkylating agent therapy. [20] Other recommendations on HCT therapy in the treatment of multiple myeloma are in the evidence-based guidelines published in 2003 by the ASBMT. [22]
Autologous transplantation can often significantly lengthen survival, however, nearly all patients face eventual disease progression and relapse. One approach to address this is tandem autologous transplants, which in recent studies have shown better results than a single procedure. [23,24]
Another approach that has shown promise is an autologous transplant followed by a non-myeloablative allogeneic transplant. [25] These two approaches are currently being studied in a large phase III multi-center trial by the BMT CTN. [26]
Figure 14.
Probability of Survival after Hematopoietic Stem Cell Transplants for Multiple Myeloma, 2000-2009, by donor type. (CIBMTR data)
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Non-Hodgkin lymphoma (NHL)
For patients with diffuse large cell lymphoma or follicular lymphoma, data from CIBMTR (Figures 15 and 16) show that autologous hematopoietic cell transplant outcomes are better in patients with chemotherapy-sensitive disease.
For diffuse large B-cell lymphoma, autologous transplantation provides a significant survival benefit and is recommended as part of salvage therapy for patients with chemosensitive relapsed disease. [27] The role of allogeneic transplant for NHL is under evaluation. Data from the CIBMTR for transplants using HLA-identical sibling donors show better outcomes in patients transplanted with chemotherapy-sensitive disease (Figures 17 and 18).
Figure 15.
Probability of Survival after Autotransplants for Diffuse Large B-Cell Lymphoma, 2000-2009, by disease status. (CIBMTR data)
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Figure 16.
Probability of Survival after Autotransplants for Follicular Lymphoma, 2000-2009, by disease status. (CIBMTR data)
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Figure 17.
Probability of Survival after HLA-Identical Sibling Allotransplants for Follicular Lymphoma, 2000-2009, by disease status. (CIBMTR data)
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Figure 18.
Probability of Survival after HLA-Identical Sibling Allotransplants for Diffuse Large B-Cell Lymphoma, 2000-2009, by disease status. (CIBMTR data)
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Reviews of transplants for lymphomas reported to European and American registries from 1985-1998 have showed that relapse rates were better following allogeneic transplant for NHL. Nevertheless, because of high transplant-related mortality associated with allogeneic transplant, the overall survival was higher after autologous transplants. [28,29] The ASBMT evidence-based review on the use of HCT to treat follicular lymphoma states that autologous transplantation is the preferred treatment for transformed follicular lymphoma. [30]
Most patients with unrelated donors are transplanted at disease recurrence. Graft source (marrow or PBSC) has no significant impact on unrelated donor outcomes when using non-myeloablative preparative conditioning regimens (Figure 19).
Figure 19.
NHL: Survival of adult non-myeloablative transplant patients, unrelated donor transplants facilitated by the NMDP, by cell source, 2000-2009. (NMDP data)
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See further explanation of Figure 19 with downloadable PowerPoint® slides.
The rates of allogeneic transplant-related mortality have continued to improve, and studies to evaluate the potential of allogeneic transplant in NHL treatment are ongoing. Patients' individual risk factors determine the recommended time for transplant; for many patients, transplant is considered at relapse (for details see the Recommended Timing for Transplant Consultation).
Hodgkin disease
The use of high-dose therapy with autologous hematopoietic cell transplant is considered standard therapy for patients with chemosensitive relapsed and primary refractory Hodgkin disease (also called Hodgkin lymphoma). [31] Studies have shown that active disease at the time of transplant and the number of previous chemotherapy treatments both have a significant influence on survival after transplant. [32,33]
Data from the CIBMTR also show the probability of survival after autologous transplant is better when it is performed during complete remission than during non-remission (Figure 20). Transplantation for patients who respond to therapy may therefore be considered early in the course of the disease, before the development of chemotherapy resistance and cumulative organ toxicity. [32,33] (See the Recommended Timing for Transplant Consultation.)
The use of allogeneic transplantation in treating Hodgkin disease remains controversial. In one study of the EBMT registry of patients receiving transplants for lymphomas, Hodgkin disease was the only lymphoma where relapse-free survival was poorer after allogeneic transplant than after autologous transplant. [28]
However, a smaller study of 157 patients with relapsed or refractory Hodgkin disease transplanted at Johns Hopkins Oncology Center between 1985 and 1998 found signs of a graft-versus-Hodgkin disease effect and a lower risk of secondary AML/MDS following allogeneic transplant compared to autologous transplant, and recommended further study. [34]
Figure 20.
Probability of Survival after Autotransplants for Hodgkin Disease, 2000-2009, by disease status. (CIBMTR data)
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Other diseases
The following five curves show survival data from the NMDP and the CIBMTR of other diseases for which HCT can be a curative therapy.
Fanconi anemia
Figure 21.
Fanconi anemia: Overall survival of pediatric patients (age <18 years), unrelated donor non-myeloablative transplants, by cell source, facilitated by the NMDP, 2000-2009. (NMDP data)
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Severe aplastic anemia
Figure 22.
Severe aplastic anemia: Overall survival of adult (age ≥18 years) and pediatric (age <18 years) Patients, unrelated donor marrow transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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Figure 23.
Probability of Survival after Allotransplants for Severe Aplastic Anemia, 2000-2009, by donor type and age. (CIBMTR data)
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Inherited immune system disorders
Figure 24.
Inherited immune system disorders: Overall survival of patients with severe combined immunodeficiency (SCID) and Wiskott-Aldrich syndrome (WAS), unrelated donor marrow transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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Inherited metabolic disorders
Figure 25.
Inherited metabolic disorders: Overall survival of pediatric (age <18 years) patients with adrenoleukodystrophy (ALD)/metachromatic leukodystrophy (MLD) or Hurler syndrome, unrelated donor transplants facilitated by the NMDP, 2000-2009. (NMDP data)
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References
Acute lymphoblastic leukemia
- Kiehl MG, Kraut L, Schwerdtfeger R, et al. Outcome of allogeneic hematopoietic stem-cell transplantation in adult patients with acute lymphoblastic leukemia: No difference in related compared with unrelated transplant in first complete remission. J Clin Oncol. 2004; 22(14): 2816-2825.
http://www.jco.org/cgi/content/full/22/14/2816
- Rowe JM, Buck G, Fielding A, et al. In adults with standard-risk acute lymphoblastic leukemia (ALL) the greatest benefit is achieved from an allogeneic transplant in first complete remission (CR) and an autologous transplant is less effective than conventional consolidation/maintenance chemotherapy: Final results of the international ALL trial (MRC UKALL XII/ECOG E2993) [abstract]. Blood 2006; 108(11), abstract #2.
http://abstracts.hematologylibrary.org/cgi/content/abstract
/ashmtg;108/11/2
- Weisdorf D, Bishop M, Dharan B, et al. Autologous versus allogeneic unrelated donor transplantation for acute lymphoblastic leukemia: comparative toxicity and outcomes. Biol Blood Marrow Transplant. 2002; 8(4): 213-220.
http://www.bbmt.org/article/S1083-8791(02)50043-4/fulltext
- Hunault M, Harousseau JL, Delain M, et al. Better outcome of adult acute lymphoblastic leukemia after early genoidentical allogeneic bone marrow transplantation (BMT) than after late high-dose therapy and autologous BMT: a GOELAMS trial. Blood. 2004; 104(10): 3028-3037.
http://www.bloodjournal.org/cgi/content/full/104/10/3028
- Hahn T, Wall D, Camitta B, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute lymphoblastic leukemia in adults: An evidence-based review. Biol Blood Marrow Transplant. 2006; 12(1): 1-30.
http://www.bbmt.org/article/PIIS1083879105007184/fulltext
- Hahn T, Wall D, Camitta B, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute lymphoblastic leukemia in children: An evidence-based review. Biol Blood Marrow Transplant. 2005; 11(11): 823-861.
http://www.bbmt.org/article/PIIS1083879105005677/fulltext
Acute myelogenous leukemia
- Löwenberg B, Griffin JD, Tallman MS. Acute myeloid leukemia and acute promyelocytic leukemia. Hematology 2003: American Society of Hematology Education Program Book. 82-101.
- Oliansky DM, Appelbaum F, Cassileth PA, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute myelogenous leukemia in adults: an evidence-based review. Biol Blood Marrow Transplant. 2008; 14(2):137-180.
http://www.bbmt.org/article/PIIS108387910700571X/fulltext
- Oliansky DM, Rizzo JD, Aplan PD, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of acute myeloid leukemia in children: an evidence-based review. Biol Blood Marrow Transplant. 2007; 13(1):1-25.
http://www.bbmt.org/article/PIIS1083879106007348/fulltext
Chronic myelogenous leukemia
- Jabbour E, Cortes J, Kantarjian HM, et al. Allogeneic stem cell transplantation for patients with chronic myeloid leukemia and acute lymphocytic leukemia after Bcr-Abl kinase mutation–related imatinib failure. Blood. 2006; 108(4):1421-1423.
http://bloodjournal.hematologylibrary.org/cgi/content/full/108/4/1421
- Weisdorf DJ, Anasetti C, Antin JH, et al. Allogeneic bone marrow transplantation for chronic myelogenous leukemia: comparative analysis of unrelated versus matched sibling donor. Blood. 2002; 99(6):1971-1977.
http://www.bloodjournal.org/cgi/content/full/99/6/1971
- Davies SM, DeFor TE, McGlave PB, et al. Equivalent outcomes in patients with chronic myelogenous leukemia after early transplantation of phenotypically matched bone marrow from related or unrelated donors. Am J Med. 2001; 110(5):339-346.
http://www.amjmed.com/article/S0002-9343(01)00629-5/abstract
- Melo JV, Hughes TP, Apperley JF. Chronic Myeloid Leukemia. Hematology 2003: American Society of Hematology Education Program Book. 132-152.
http://www.asheducationbook.org/cgi/content/full/2003/1/132
- Maziarz RT, Mauro MJ. Mini Review: Transplantation for chronic myelogenous leukemia: yes, no, maybe so … an Oregon perspective. Bone Marrow Transplant. 2003; 32(5):459-469.
http://www.nature.com/bmt/journal/v32/n5/full/1704163a.html
- Guglielmi C, Arcese W, Dazzi F, et al. Donor lymphocyte infusion for relapsed chronic myelogenous leukemia: prognostic relevance of the initial cell dose. Blood. 2002; 100(2):397-405.
http://www.bloodjournal.org/cgi/content/full/100/2/397
- Crawley C, Szydlo R, Lalancette M, et al. Outcomes of reduced-intensity transplantation for chronic myeloid leukemia: an analysis of prognostic factors from the Chronic Leukemia Working Party of the EBMT. Blood. 2005; 106(9):2969-2976.
http://www.bloodjournal.org/cgi/content/full/106/9/2969
Myelodysplastic syndromes
- Castro-Malaspina H, Harris RE, Gajewski J, et al. Unrelated donor marrow transplantation for myelodysplastic syndromes: outcome analysis in 510 transplants facilitated by the National Marrow Donor Program. Blood. 2002; 99(6):1943-1951.
http://www.bloodjournal.org/cgi/content/full/99/6/1943
- Cutler CS, Lee SJ, Greenberg P, et al. A decision analysis of allogeneic bone marrow transplantation for the myelodysplastic syndromes: delayed transplantation for low-risk myelodysplasia is associated with improved outcome. Blood. 2004; 104(2):579-585.
http://www.bloodjournal.org/cgi/content/full/104/2/579
- Oliansky DM, Antin JH, Bennett JM, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of myelodysplastic syndromes: an evidence-based review. Biol Blood Marrow Transplant. 2009; 15(2):137-172.
http://www.bbmt.org/article/S1083-8791(08)00590-9/fulltext
Multiple myeloma
- Position Statement of the American Society for Blood and Marrow Transplantation. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of multiple myeloma. 2003.
http://www.asbmt.org/displaycommon.cfm?an=4
- Crawley C, Lalancette M, Szydlo R, et al. Outcomes for reduced-intensity allogeneic transplantation for multiple myeloma: an analysis of prognostic factors from the Chronic Leukaemia Working Party of the EBMT. Blood. 2005; 105(11):4532-4539.
http://www.bloodjournal.org/cgi/content/full/105/11/4532
- Hahn T, Wingard JR, Anderson KC, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the therapy of multiple myeloma: An evidence-based review. Biol Blood Marrow Transplant. 2003; 9(1):4-37.
http://www.bbmt.org/article/PIIS1083879102000058/fulltext
- Attal M, Harousseau J-L, Facon T, et al. Single versus double autologous stem-cell transplantation for multiple myeloma. N Engl J Med. 2003; 349(26):2495-2502.
http://content.nejm.org/cgi/content/full/349/26/2495
- Cavo M, Cellini C, Zamagni E, et al. Superiority of double over single autologous stem cell transplantation as first-line therapy for multiple myeloma [abstract]. Blood. 2004; 104(11): abstract 536.
http://abstracts.hematologylibrary.org/cgi/content/full/104/11/536
- Bruno B, Rotta M, Patriarca F, et al. A comparison of allografting with autografting for newly diagnosed myeloma. N Engl J Med. 2007; 356(11):1110-1120.
http://content.nejm.org/cgi/content/full/356/11/1110
- Blood and Marrow Transplant Clinical Trials Network (BMT CTN). BMT CTN protocol 0102: A trial of tandem autologous stem cell transplants +/- post second autologous transplant maintenance therapy versus single autologous stem cell transplant followed by matched sibling nonmyeloablative allogeneic stem cell transplant for patients with multiple myeloma. Version 7.0, 2006.
https://web.emmes.com/study/bmt2/protocol/0102_protocol/0102_protocol.html
Non-Hodgkin lymphoma
- Position Statement of the American Society for Blood and Marrow Transplantation. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of diffuse large cell B cell lymphoma: Update of the 2001 evidence-based review. 2011.
http://www.asbmt.org/displaycommon.cfm?an=4
- Peniket AJ, Ruiz de Elvira MC, Taghipour G, et al. An EBMT registry matched study of allogeneic stem cell transplants for lymphoma: allogeneic transplantation is associated with a lower relapse rate but a higher procedure-related mortality rate than autologous transplantation. Bone Marrow Transplant. 2003; 31(8):667-678.
http://www.nature.com/bmt/journal/v31/n8/full/1703891a.html
- Bierman PJ, Sweetenham JW, Loberiza FR Jr, et al. Syngeneic hematopoietic stem-cell transplantation for non-Hodgkin's lymphoma: A comparison with allogeneic and autologous transplantation — the lymphoma working committee of the International Bone Marrow Transplant Registry and the European Group for Blood and Marrow Transplantation. J Clin Oncology. 2003; 21(20):3744-3753.
http://www.jco.org/cgi/content/full/21/20/3744
- Oliansky DM, Gordon LI, King J, et al. The role of cytotoxic therapy with hematopoietic stem cell transplantation in the treatment of follicular lymphoma: an evidence-based review. Biol Blood Marrow Transplant. 2010; 16(4):443-468.
http://www.bbmt.org/article/S1083-8791(10)00024-8/fulltext
Hodgkin disease
- Moskowitz CH. Controversies in the management of relapsed and primary refractory Hodgkin's lymphoma. American Society of Clinical Oncology Educational Book. 2004. 360-367.
- Czyz J, Dziadziuszko R, Knopinska-Postuszuy W, et al. Outcome and prognostic factors in advanced Hodgkin's disease treated with high-dose chemotherapy and autologous stem cell transplantation: a study of 341 patients. Ann Oncology. 2004; 15(8):1222-1230.
http://annonc.oupjournals.org/content/15/8/1222.full
- Sureda A, Arranz R, Iriondo A, et al. Autologous stem-cell transplantation for Hodgkin's disease: results and prognostic factors in 494 patients from the Grupo Español de Linfomas/Transplante Autólogo de Médula Ósea Spanish Cooperative Group. J Clin Oncology. 2001; 19(5):1395-1404.
http://www.jco.org/cgi/content/full/19/5/1395
- Akpek G, Ambinder RF, Piantadosi S, et al. Long-term results of blood and marrow transplantation for Hodgkin's lymphoma. J Clin Oncology. 2001; 19(23):4314-4321.
http://www.jco.org/cgi/content/full/19/23/4314