BONE-MARROW TRANSPLANTATION FOR RELAPSED ACUTE LYMPHOBLASTIC-LEUKEMIA

Bone marrow transplantation (BMT) is increasingly being recommended fo r relapsed acute lymphoblastic leukemia (ALL). A number of transplant options exist, although the best results have used HLA-matched sibling donors. Allogeneic BMT using closely matched unrelated donors and par tially matched or haploidentical family member donors have become more popular with improvements in control of graft rejection and graft-ver sus-host disease. Autologous transplantation is also an option for rel apsed ALL although these types of transplants continue to be associate d with higher secondary relapse rates. Despite many advances in the tr ansplant field, the best myeloablative preparative regimen for BMT is still unknown. The toxicity of these regimens continues to contribute to significant posttransplant morbidity, prompting consideration of st andard chemotherapy for a select,group of patients with relapsed ALL. Better recognition and treatment of many post-transplant complications have led to improved overall survival in BMT patients over the past 1 0 years. This article will review the different types of transplants p erformed in children with relapsed ALL and detail some of the present controversies in this area.