Bone marrow transplantation in first remission.

The allogeneic bone marrow transplant experience for acute myeloid leukemia (AML) is broader than that for acute lymphocytic leukemia (ALL). However, data describing disease-free survival in AML in first remission in the range of 40% to 65% are almost identical to the data from larger studies of ALL in first remission. Similarly, the published allogeneic transplant data for ALL in second remission are comparable to those in the AML experience. The efficacy of autologous stem-cell transplantation for ALL, while promising, remains unproven in first remission, and larger multicenter studies are underway to answer this question. Until prospective randomized trials of bone marrow or peripheral-blood stem-cell purging have been performed, a conclusion that ex vivo bone marrow transplantation is of clinical benefit for any patient with ALL will be impossible. Such studies will be difficult to conduct and, in an autologous setting, should include genetic marking to help determine whether reinfused leukemic cells will lead to relapse.