Bone marrow transplantation.

Abstract

The goals in bone marrow transplantation are its application to the treatment of diseases arising in the blood-forming tissues of man. Techniques for procuring and grafting marrow are of the needle-and-syringe type and are based on the normal physiological processes in which stem cells circulate through blood and other fluids of the mammalian organism. Destruction of bone marrow by irradiation, chemicals, or unknown agencies provides the immediate experimental system for demonstrating the therapeutic value of marrow transplants. Genetic diseases characterized by abnormal marrow function are also modifiable by grafts of blood-forming tissues. Studies with identical twins are critical experiments for showing the clinical value of grafts, even though the transplanted cells cannot be identified by the usual marker techniques. Among the best results seen with marrow grafting is the presumed cure of certain rare hereditary immune-deficiency disorders of children. A major problem in bone marrow transplantation-one that delays its wider clinical application-is the immune reaction from cells growing out of the foreign transplant which attack the host (the graft-versus-host reaction). Attempts to use a graft-versus-host response to eliminate tumor cells is a part of the marrow research program. The history of the processes that led to some of the achieved goals in marrow grafting shows the usual multicentric origin of an idea. Certain individuals play critical roles in developing the idea. Finally, a body of knowledge is accumulated that opens up or limits prospects for the future. In bone marrow transplantati on, future achievements will depend in part on the progress that is made in the areas of cell separation, bone marrow banking, and tissue culture.