Bone marrow transplantation for children with acute myelogenous leukemia

This article reviews bone marrow transplantation (BMT) in acute myelogenous leukemia (AML) of children from adoption of allogeneic BMT for children in first complete remission to the present where autologous BMT, marrow purging, and alternative donors are the major issues. Match related BMT in first remission achieved long-term disease free survival in well over half the young patients. However, as only 25-30% of patients have a matched sibling donor, other options for BMT has been explored, including autologous BMT and unrelated donor BMT. There are many issues that require further study regarding autologous transplant, including the efficacy and benefits of marrow purging. Unrelated donor transplants offer encouraging results in suitable patients, but bring with them the increased risk of complications. BMT is also successful in some children in second remission or who have refractory disease. A recent development in the transplant of children with AML is the use of nonradiation-containing conditioning regimens to avoid potential long-term sequelae of total body irradiation. Nonradiation regimens appear to be as efficacious as radiation-containing regimens for these children. The superiority of BMT over chemotherapy has recently been challenged, as improved supportive care and extremely intensive therapy have resulted in approximately 75% of children achieving a remission and 30-40% of patients surviving. Recent studies have focused upon answering the question regarding the role of BMT in children in first remission. Strategies to improve the outcome of BMT and comparison sequelae of BMT to those on high dose chemotherapy are issues that need to be addressed.