There has been a great deal of interest in the use of high dose chemot
herapy and/or radiotherapy, with autologous bone marrow/peripheral blo
od stem cell rescue, in the treatment of haematological malignancies i
ncluding acute lymphoblastic leukaemia (ALL). In this review we assess
the role of autologous bone marrow transplantation (ABMT) in ALL. The
heterogeneity of this disease makes the analysis of treatment results
in ALL difficult to interpret. There is some evidence that ABMT may b
e useful in second complete remission (CR) and increasing interest in
ABMT as a therapeutic option in first CR in adults. At the moment ther
e is little evidence that such an approach will have an impact in chil
dhood ALL. ABMT is considerably less toxic than allogeneic bone marrow
transplantation and the major cause of 'treatment failure' is disease
relapse. There has been considerable effort put into purging autologo
us bone marrow of malignant stem cells but whether purging is effectiv
e remains controversial and not proven. Newer studies involving cytoki
nes post-ABMT to stimulate an artificial 'graft versus leukaemia' effe
ct may prove of value.