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Bone Marrow Transplantation The use of bone marrow transplantation as
a therapeutic approach for ALL patients who have suffered a bone marrow relapse has
increased in recent years .
This approach involves the
administration of intensive cytoreductive therapy , usually employing total body
irradiation and high-dose chemotherapy in doses lethal to normal bone marrow and
subsequent hematopoietic "rescue" with intravenously infused bone marrow
obtained from a compatible donor . To some degree, the initial interest in bone marrow
transplantation was Continual innovation and technological refinements have given bone
marrow transplantation a significant role in the treatment of
childhood
ALL .
Currently , allogeneic marrow
transplantation is routinely advocated , particularly for patients in second remission who
have an appropriate donor . In this group of patients, overall disease-free survivals
range from approximately 40% to more than 60%
.
Better results are obtained in
patients transplanted in remission than in those in relapse or partial remission . In most
studies patients transplanted in earlier remissions fare significantly better than
patients transplanted after multiple relapses .
The length of first remission and high-risk features at diagnosis are predictive factors .
Patients with shorter initial
remissions and those with high-risk features at diagnosis fare worse when transplanted in
second remission .
Most studies that have compared the efficacy of allogeneic marrow transplantation with
chemotherapy for patients who had experienced a previous relapse indicate that
transplantation is associated with a superior outcome . Marrow transplantation appears to
be particularly advantageous for patients who fare less well on their initial chemotherapy
regimens .
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What is BMT