Allogeneic Marrow Transplantation for Acute Leukemia

Abstract

Remarkable advances in marrow transplantation for acute leukemia have been made since the early 1970s when treatment was restricted to patients with advanced disease, and long-term survival was only on the order of 15% [1]. In the mid-1970s marrow grafting was applied earlier, during the first remission in patients with acute nonlymphoblastic leukemia (ANL) and during second or subsequent remission in patients with acute lymphoblastic leukemia (ALL) [2,3]. Patients with ANL grafted in first remission have survived better than those given chemotherapy (50% versus 20% actuarial survival, with the longest survivors currently at 11 years in continued remission) [4]. Thirty-five percent of patients with ALL given grafts in second or subsequent remission have survived, whereas similar patients undergoing chemotherapy all died of recurrent disease within 31/2 years of the initiation of therapy [5]. Patients with ANL grafted in early first relapse, incurable by chemotherapy, have shown 5-year disease-free survivals on the order of 30%, which is equal to or better than that seen in patients transplanted in second remission of ANL [6].