Allogeneic bone marrow transplantation for the treatment of adult acute leukemias.

Allogeneic BMT has been shown to be a highly effective therapy for both AML and ALL. With the availability of unrelated donors, continuing advances in the development of new and more effective transplant regimens, and the identification of agents such as the hematopoietic growth factors, alprostadil, and pentoxifylline to decrease the regimen related toxicities, BMT will become a viable option for a greater number of adults with acute leukemia. The optimal timing for BMT will continue to evolve, but based upon the currently available information, patients age 55 or less with AML with a high probability of relapse based upon cytogenetic abnormalities should be considered for transplantation in first remission if a related or unrelated donor can be identified. For patients at low risk for relapse (e.g., age 25 or less who have received high-dose intensification), transplantation can be delayed until documentation of early relapse. For patients with Ph1+ ALL or t(4;11), transplantation in first remission should be considered if a suitable related or unrelated donor is identified. Adults with ALL without adverse prognostic characteristics should be considered for transplantation at relapse or in second remission.