Current status of allogeneic bone marrow transplantation in leukemia: a report from the International Bone Marrow Transplant Registry.

Utilization of bone marrow transplantation as a therapeutic modality continues to increase. During the 32 years between 1955 and 1986 more than 15,000 patients received allogeneic transplants; more than 50% of these were performed in the 3 years, 1984 to 1986. Transplantation is an effective therapy for acute leukemias; in some instances it is the preferred treatment. In chronic myelogenous leukemia, aplastic anemia, and some genetic and immune deficiency diseases, bone marrow transplantation provides the only possibility for cure. Bone marrow transplantation is investigational in other conditions and is associated with substantial problems such as graft-vs-host disease, interstitial pneumonitis, and the requirement for an HLA-identical donor. Recently an increasing number of transplants have been performed using HLA partially or fully matched related or unrelated donors with some success. The development of AGVHD and interstitial pneumonitis can to some extent be predicted by risk factor assessment. AGVHD can be prevented by depletion of T cells from the donor bone marrow but this is associated with an increased risk of graft rejection and leukemia relapse. Interstitial pneumonitis can be modified by prophylaxis with CMV immune globulin and by the use of CMV-negative blood donors. In this report we summarized data from the International Bone Marrow Transplant Registry concerning allogeneic bone marrow transplantation in leukemia.