Allogeneic bone marrow transplantation.

Abstract

Allogeneic bone marrow transplantation now has an established place in the treatment of severe aplastic anemia and acute leukemia. Major problems to be overcome in transplantation in patients with aplastic anemia are marrow graft rejection and graft vs. host disease. Results are better in younger patients and in patients who have not been previously transfused. Newer approaches to the control of graft vs. host disease, for example total lymphoid irradiation and the immunosuppressive agent, cyclosporin A, hold promise for future progress. In patients with acute leukemia, the major clinical problems are early infections, recurrent leukemia, graft vs. host disease, and interstitial pneumonia. Both ultra-isolation and prophylactic granulocyte transfusions are able to decrease the incidence of early infections. Attempts to intensify the conditioning regimen have failed to decrease the incidence of recurrent leukemia, but transplantation earlier in the course of disease, particularly in patients with acute, nonlymphoblastic leukemia in first remission, have decreased the incidence of recurrent leukemia. Both acute and chronic forms of graft vs. host disease have been recognized. Acute graft vs. host disease continues to be a significant clinical problem, in spite of the use of Cyclosporin A. Chronic graft vs. host disease is being recognized earlier and treated successfully with immunosuppressive agents. Interstitial pneumonia, primarily secondary to cytomegalovirus, remains the major cause of death post-transplantation. In spite of these problems, however, patients with acute non-lymphoblastic leukemia in first remission have a 60% likelihood of remaining alive, free of disease following allogeneic marrow transplantation from an HLA identical sibling. Patients with acute leukemia who have relapsed who undergo allogeneic marrow transplantation have a longer survival than patients treated with conventional chemotherapy and even patients in relapse have a significant likelihood of cure following high-dose chemoradiotherapy and allogeneic marrow transplantation.