[Indication of bone marrow transplantation for acute leukemia in first remission]

We presented the results of Kanazawa experience and suggested integrative approach for treatment of acute leukemia in first remission. From 1977 to 1990, 23 patients with acute leukemia (AL) in first remission (ALL 13; ANL 10) were received marrow transplantation from HLA matched donor (allogeneic 22, syngeneic 1) after conditioning with CY + TBI (17), BU + CY (5) or AraC + BU + CY (1). Probability of 5 year survival in all AL patients is 52% (ALL 69%, ANL 30%). Relapse rate in all AL is 22% (ALL 38%, ANL 0%). The results of high risk ALL is superior to alternative approach of initial chemotherapy plus transplantation in subsequent remission. In addition, after 1987, there is no fatal cases within 100 days after transplantation. From current status of marrow transplantation and chemotherapy, together with our experience, we recommended initial allogeneic BMT for ANL and high risk adult ALL in first remission. BMT from unrelated matched donor or autologous marrow should be considered next. For high risk child ALL and low risk adult ALL, initial allogeneic BMT should be considered if related matched donor is available.