Recent trends in allogeneic bone marrow transplantation

The indications and results of allogeneic bone marrow transplantation are well known by the analyses of European and International registries. In acute nonlymphoblastic leukemia in first CR, the disease-free survival (DFS) is 45% with a risk of relapse (RR) of 15%, in ALL in first CR the DFS is 60% with a RR of 15%, in ALL in second CR the DFS is 40% with a RR of 30%, and in CML in the chronic phase the DFS is 60%, with a RR of 20%. These results must be adjusted with other risk factors such as age, sex mismatch, disease status, CMV serology, and GvHD. The use of donors who differ from genotypically matched related donors is currently under investigation. Mismatched related transplants give disappointing results except in the case of 1 HLA mismatch. Unrelated HLA-matched donor panels have recently been established in various countries with 200 transplants performed with a DFS of approximately 40%. Researchers are currently trying to reduce the RR by intensifying the conditioning regimen or using the graft-versus-leukemia effect of allogeneic T cells, reducing GvHD by the use of monoclonal antibodies, and improving the engraftment by the use of growth factors. The recent use of cryopreserved cord blood cells for transplantation may improve the results of partially mismatched transplants in children.