Bone marrow transplantation for acute nonlymphocytic leukemia (ANL)

When a patient less than age 55 presents with ANL, it can be recommended that the patient and his family be HLA typed prior to initial induction chemotherapy. The information gained may be of help for platelet support but, more importantly, if the patient fails to achieve a remission, transplantation can be carried out straight away. If the patient achieves a first complete remission, the therapeutic approach depends upon whether a donor is found. If either a matched or one-antigen mismatched family member is identified, transplant in first remission or first relapse can be recommended. If no match is found, autologous marrow should be stored and a search for an unrelated donor be initiated. Currently, we generally restrict the use of autologous marrow or an unrelated donor to patients who have suffered an initial relapse, unless in the context of a specific clinical protocol. Which of the two approaches, autologous versus unrelated, is superior remains unknown.