Bone marrow transplantation for hematologic malignancies and cancer

Over 20 years marrow transplantation has evolved from an experimental treatment for patients with advanced acute leukemia to the treatment of choice for any acute leukemia that has recurred at least once, for relapsed aggressive non-Hodgkin's lymphoma (NHL) or Hodgkin's disease, for acute myeloid leukemia in first remission, and for chronic myelocytic leukemia. It is the only curative treatment for chronic lymphocytic leukemia, myelodysplasia, multiple myeloma, and low-grade NHL. Increasingly it is used as treatment for some solid tumors where best results have been seen when bone marrow transplantation is used as an adjuvant therapy for patients with low tumor burden. Critical to further progress is the development of more effective, yet safer conditioning programs to eradicate host tumor and immune cells. Continued research with recombinant molecules and the expected proliferation of recombinant and pharmaceutical products should facilitate continued improvements in results of clinical marrow transplantation.