The PARMA trial clarified the role of hematopoietic stem cell transplant in patients with non-Hodgkin's lymphoma in chemotherapy-sensitive relapse. With the goal of improving overall response and survival rates, hematopoietic stem cell transplant has been incorporated into the front-line treatment plan in some studies. While multiple clinical trials have been designed to address this issue, they have varied in their treatment regimens, patient populations and outcomes. This review will summarize and analyze the data obtained so far and provide practitioners with recommendations for the application of high-dose chemotherapy and hematopoietic stem cell transplant as part of the initial treatment of patients with both indolent and aggressive non-Hodgkin's lymphoma. Based upon the current literature, hematopoietic stem cell transplant cannot be recommended as first-line therapy in patients with non-Hodgkin's lymphoma outside the setting of a clinical trial.