Bone Marrow Transplantation in Leukemia in the Absence of an HLA-Identical Sibling Donor

Abstract

Bone marrow transplantation is a potentially curative treatment for patients with leukemia, aplastic anemia, metabolic disorders, and immunodeficiency. One of the main problems of this procedure is the graftversus-host reaction induced in the recipient by the immune function of the transplanted marrow. In order to minimize the risks of graft rejection and graft-versus-host disease (GVHD), marrow transplantation has in general been limited to patients with HLA-identical sibling donors. The majority of patients, however, will not have such a family member available. To cope with such patients, several alternative approaches have been investigated. One of them is autologous bone marrow transplantation (with or without antileukemic treatment of the marrow); another is transplantation of haploidentical marrow after T-cell depletion by separation with lectins, E rosetting, or monoclonal antibodies.