Allogeneic and autologous bone marrow transplantation for acute leukemia and malignant lymphoma: Current status

Abstract

The current status of autologous and allogeneic marrow transplantation for acute leukemias and malignant lymphoma is reviewed and compared to the current status of conventional chemotherapy. Based on the reviewed literature, it is concluded that marrow transplantation and conventional chemoradiotherapy are not mutually exclusive and that for most young patients with acute hematological malignancies the question is not if, but rather when to intervene with a marrow transplant treatment. Thus marrow transplantation and conventional chemoradiotherapy can work as complimentary units in the complex therapeutic approach needed to cure most patients with hematological malignancies.

Bone Marrow Transplantation

“…In another update of 20 patients with AML, the actual 4-year and actuarial 10-year survival was 60%, with a 4-and 10-year RI of 14% [327], thus confirming the rarity of the late and very late relapses that were discussed previously [181,186]. The key role of CR1 status in ensuring a favourable outcome has been confirmed and stressed in all recent surveys [11,[14][15][16]23,33,[108][109][110]328], and is shown most clearly in Fig. 12, reporting the most recent IBMTR data.…”

“…This impressive development is reflected in an equally impressive number of articles and in a series of monographs, symposia proceedings and review articles. Leaving aside the less recent literature, AlloBMT has been the object of 6 monographs and monographic journal issues [18][19][20][21][22][23][24], 4 UCLA [25][26][27] and 15 EBMT meeting proceedings, of which only the last 4 will be indicated [28], other symposia [29] and a number of review articles [30][31][32][33][34].…”

“…Notwithstanding some diversity in the evaluation of both acute [199] and chronic [200] GvHD, the general consensus is that aGvHD occurs in 45% of transplant recipients and is fatal in about 25% [23,201]. Apart fro~ being the most important expression of the immune conflict between donor and host cells after AlloBMT, GvHD is an extremely important clinical complication and has been studied exten~ively, both in its acute [202][203][204] and chromc [206,207] forms.…”

“…There were striking differences in the utilisation of AutoBMT between North America and Europe [440], in the sense that lymphomas and solid tumours were the main indication in North America, while leukaemia was the main indication in Europe. A number of reviews [23,38,39,115,441,442] and two outstanding volumes [35,36] have been published. Comprehensive reports on AutoBMT for malignant lymphomas [443][444][445], with special emphasis on the Hodgkin [446][447][448] and non-Hodgkin [449,450] categories, neuroblastoma [451] and other chemosensitive solid tumours [452,453] have also appeared recently.…”