[Allogenic bone marrow transplantation in acute leukemia]

Allogeneic bone marrow transplantation (BMT) allows application of supraletal chemoradiotherapy thereby sparing of hemopoietic tissue. After ablation of hematopoiesis bone marrow of a healthy and HLA-identical donor has to be transplanted. During aplasia patients require maintenance in sterile units (reverse isolation or lamina air flow). These together with intestinal decontamination is aimed to reduce the occurrence of infections in these severely immunocompromised patients. To minimize BMT-specific complications such as marrow graft rejection, Graft versus host disease (GVHD) or infections with cytomegalovirus or pneumocystis carinii various prophylactic measures are given. In younger patients with acute myeloid leukemia (AML) in first complete remission cure can be achieved in up to 70% by allogeneic BMT. If BMT is performed beyond first remission cure can be expected in about 20%. In acute lymphoblastic leukemia (ALL) the situation is more complex; besides blood cell count at diagnosis variables such as cytogenetics, immunophenotype, response to induction therapy and patient's age have to be taken into account for ultimate therapeutic decisions.