[Marrow transplantation in leukemia-recent trends]

Due to progress in conventional chemotherapy 50-60% of children with acute leukemia can be cured today. Despite these good results, however, 40-50% eventually will relapse and die. Other therapeutic modalities are therefore needed. Transplantation of bone marrow from an HLA-identical sibling offers this possibility. Initiated a decade ago as last therapy for end stage disease patients marrow transplantation is a well tolerated therapy today with well defined risks. In adults, marrow transplantation is clearly superior to conventional chemotherapy if performed early. The incidence of severe Graft-versus-Host-Disease, the major complication of marrow transplantation is much less after early transplantation and Cyclosporin-A, a new immunosuppressive agent further reduces severity of Graft-versus-Host-Disease. Since all complications are less in younger patients marrow transplantation is the therapy of choice for a child with leukemia having an HLA-identical sibling donor.