Bone marrow transplant for Leukemia during first remission remains controversial. In adult Leukemia, long-term disease-free survival rates range from 35 to 40 percent with chemotherapy alone and from 45 to 75 percent with allogeneic transplantation. However, interpretation of these results is difficult because of the lack of true randomization. Even so, results of both the adult and paediatric studies suggest allogeneic transplantation benefits some high-risk patients.
Prognosis FOR Bone Marrow Transplant for Leukemia-
Because of their unfavourable prognosis, patients with the Philadelphia-chromosome–positive Acute lymphoblastic leukemia and those with a poor initial response to induction therapy commonly were recommended to undergo allogeneic Bone Marrow Transplant for Leukemia during the first remission. However, the advent of improved chemotherapy has decreased the survival advantage of transplantation in children with Philadelphia-chromosome–positive leukemia.
The use of a tyrosine kinase inhibitor has further improved the early treatment results, casting doubt on the use of transplantation in first remission in childhood cases.
Allogeneic Bone Marrow Transplant for Leukemia-
Allogeneic Bone Marrow Transplant for Leukemia appeared to improve the outcome of adults with the t(4;11), but not that of children or infants with the same genotype. Allogeneic transplantation has not been superior to chemotherapy in adults with standard-risk leukemia. More recently, reduced intensity conditioning allografting yielded promising leukemia free survival in a study of adult leukemia. Thus, the indications for allogeneic transplantation in first remission should be reevaluated as chemotherapy and transplantation continue to improve.
Autologous Bone Marrow Transplant for Leukemia-
Autologous transplantation failed to improve outcome in adult leukemia, mainly because of high rate of relapse (~50%). The main advantage of autologous transplant is a short total duration of therapy, which is counterbalanced by more late effects because of the use of total-body irradiation.
Comparative outcomes between cord blood transplantation and bonemarrow or peripheral blood stem cell transplantation from unrelated donors in patients with hematologic malignancies: a single-institute analysis.