Bone marrow transplantation for acute lymphocytic leukemia (ALL)

Patients with high-risk acute lymphocytic leukemia (ALL) in first complete remission, or those with relapsed leukemia, are unlikely to have their disease controlled by conventional therapeutic approaches. Bone marrow transplantation has been shown to produce extended leukemia-free survival for a substantial number of patients, making it the preferred treatment approach. However, differential availability, transplant-associated mortality, and antileukemic efficacy of various transplant options makes the choice between donor-cell sources problematic. Currently, patients can have transplantation therapy using either autologous marrow cryopreserved with or without purging, allogeneic related-donor, or umbilical-cord blood cells used for reconstitution. Transplants with autologous marrow or related-donor marrow can be undertaken with relative speed. In contrast, searching for an available unrelated living donor and the logistics of arranging for a donor harvest requires several months. Use of umbilical cord blood is more expeditious and may greatly accelerate the availability of unrelated allogeneic autotransplants and in the safety of unrelated-donor transplantation are needed to improve outcomes of transplantation in patients with ALL. Consideration of speedy availability, transplant-associated toxicity, and antileukemic efficacy of these varying options all need to be balanced for effective clinical decisions on transplant treatment in patients with ALL.