AUTOLOGOUS BONE-MARROW TRANSPLANTATION IN ACUTE LYMPHOBLASTIC-LEUKEMIA

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.