[Transplantation of allogenic bone marrow in the first remission in acute nonlymphoblastic leukosis: ethical risks]

Allogenic bone marrow transplantation is a choice therapy in consolidation of the first remission of acute nonlymphoblastic leucosis. Absolute confidence in this therapeutic procedure where high lethality of patients is present is ethically risky. The basic ethical risks are: real possibility to perform transplantation in potentially healthy persons in whom leukosis was eradicated by previous cytostatic therapy and the fact that results of allogenic bone marrow transplantation stagnate, while the competing forms of treatment as chemotherapy and transplantation of autologous hematopoietic cells get improved from day to day. The degree of confidence in the allogenic bone marrow transplantation exceeds quality and results of clinical studies on which it is based. The ethical risk of transplantation is higher if the donor is a woman and the recipient is a man, one-egg twins, HLA-identical non related or HLA-nonidentical related persons. Analysis of clinical studies showed that absolute confidence in allogenic bone marrow transplantation in the first remission of acute nonlymphoblastic leukosis has no valid foundation. Individualization of postinductional therapy would reduce ethical risks and improve results of allogenic bone marrow transplantation.