[Indications for allogeneic and autologous bone marrow transplantation]

In bone marrow transplantation (BMT) the main reason for early treatment failure is transplant-associated mortality (TAM) due to GvHD, interstitial pneumonia, veno-occlusive disease and infections. Since 1981, 84 consecutive HLA-identical BMT have been performed (13 aplastic anemia, 61 leukemia/lymphoma, 3 genetic diseases; mean age 28 [5-51] years) according to a standardized protocol designed to reduce TAM: fractionated, low dose rate irradiation; strict laminar air flow isolation plus complete intestinal decontamination; cyclosporine therapy for 4 months and CMV prophylaxis (hyperimmune plasma infusion, CMV-negative blood products). 11 patients (13%) died in TAM. Continuous complete remission was obtained in 78% of standard risk patients (n = 55) and 28% of high risk patients (n = 29). Mean observation time was 42 (3-116) months post transplantation. This result points to the necessity of a liberal indication for BMT early in the course of acute or chronic myelogenous leukemia, in the course of acute or chronic myelogenous leukemia, severe aplastic anemia and other eventually lethal hemato-oncological diseases.