MOGLICHKEITEN UND PROBLEME DER KNOCHENMARKTRANSPLANTATION IN DER BEHANDLUNG AKUTER LEUKAMIEN

Translated title of the contribution: Possibilities and problems of bone marrow transplantation in the therapy of acute leukemias

H. J. Kolb

Research output: Contribution to journalArticlepeer-review

Abstract

Bone marrow transplantation (bmt) allows the most intensive therapy of acute leukemia with chemotherapy and total body irradiation leading to complete marrow aplasia. Longterm remissions with a chance of cure were obtained by bmt from HLA-identical siblings in a minority of patients who failed to respond to conventional therapy. Superior results were obtained with bmt as consolidation of remissions. Bmt during the first remission of acute myeloid leukemia prevented relapse of leukemia in nearly all cases. The particular possibilities of bmt in the therapy of acute leukemia are: the application of chemotherapy with profound stem cell toxicity and total body irradiation; transplantation of healthy hemopoiesis and unchanged immune system; or reaction of allogeneic grafts against surviving leukemic cells. The particular problems of autologous bmt consist of stem cell deficiency following induction chemotherapy and of purging the marrow of leukemic cells; those of allogeneic bmt are graft-versus-host disease and interstitial pneumonias. The elimination of leukemic cells of the graft and of immunocompetent T lymphocytes for prevention of GvH disease is currently tried in patients by 'in vitro' treatment of the marrow with specific antisera. The conditions of total body irradiation with 20 Gy, an effective dose in the prophylaxis of central nervous system leukemia, have been worked out in the dog. It allows the taking of marrow grafts from histoincompatible family members and is promising with regard to its antileukemic effect. Bmt from other donors than HLA-identical siblings may facilitate treatment of almost every patient in need and enables the selection of donors with regard to their greatest genetic resistance against leukemia.

Translated title of the contributionPossibilities and problems of bone marrow transplantation in the therapy of acute leukemias
Original languageGerman
Pages (from-to)284-291
Number of pages8
JournalKlinische Padiatrie
Volume193
Issue number3
DOIs
StatePublished - 1981
Externally publishedYes

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