Bone marrow transplantation for cancer - An update

The number of allogeneic and autologous bone marrow transplants continues to grow worldwide. Bone marrow transplantation (BMT) has become standard therapy for many patients with leukemia, lymphoma, multiple myeloma and testicular cancer. Encouraging results of autologous BMT in treating patients with poor-risk breast cancer have led to this approach being tested in nationwide randomized trials. In order to increase availability and efficacy of BMT, other sources of hematopoietic cells are explored for transplantation, such as from HLA-matched unrelated volunteer donors, partially matched related donors, placental/umbilical cord blood and allogeneic peripheral blood. Relapse of original malignancy remains the main obstacle for the success of BMT. Recent clinical investigations have demonstrated that donor-derived peripheral blood leukocytes are effective in inducing remissions in patients with hematological malignancies who relapse after allogeneic BMT. BMT procedures are associated with significant complexity and should be carried out only in transplant units that meet adequate standards. In order to better define the role of BMT in treating cancer, more phase III clinical trials are needed. The future of BMT will depend on further improvements in its efficacy and economic constraints.