Common Indications for Bone Marrow Transplantation (BMT)

This is a partial list of common indications of BMT for malignant disorders.  BMT is being used for treatment of many other illnesses, some of which are rather uncommon.

Acute Myeloid Leukemia (AML)

Patients with AML are treated with induction chemotherapy first, followed by another cycle of chemotherapy called consolidation chemotherapy or, preferably, by an Allogeneic BMT. The cure rate with consolidation chemotherapy is roughly 30% in adults and 40% to 50% in children. The cure rate for adults undergoing an Allogeneic BMT is approximately 50 percent and about 70 percent in children.

For patients who fail to achieve remission following induction chemotherapy, or those who relapse following consolidation chemotherapy, an Allogeneic BMT is the only course of treatment, although not as successful. Patients who do not have a donor may undergo an Autologous or unrelated transplant, with roughly a 30-40 percent chance of cure.

Acute Lymphoid Leukemia( ALL)

Acute Lymphocytic leukemia is the most common form of leukemia in children and is highly curable with chemotherapy. For children who fail to achieve a remission with induction chemotherapy, or those children who relapse following chemotherapy, an Allogeneic BMT is the principal choice of treatment.

In Adults, ALL is a more aggressive disease and is best treated with BMT following the initial induction chemotherapy. Patients who do not have a donor may undergo an Autologous or unrelated transplant, with roughly a 40% chance of cure.

Chronic Myeloid Leukemia (CML)

Chronic Myelogenous Leukemia can be cured with Allogeneic BMT, especially when it is performed early in the course of the disease. Up to 80 percent of patients can be cured with BMT. Transplant should be considered for anyone who has CML. Those who have an identical twin or a matching sibling should be transplanted promptly, as soon as the diagnosis is established.

Transplants using a matching unrelated donor should be deferred as long as patients are in a stable phase. It is best accomplished upon a patient's transformation into the accelerated phase of the illness.

Lymphomas

Hodgkin's and Non-Hodgkin's Lymphomas

Patients with Hodgkin's Disease and non- Hodgkin's lymphomas who cannot be cured with chemotherapy, or those who relapse after chemotherapy, should undergo an Autologous BMT, rather than an Allogeneic BMT. If the disease has spread to the bone marrow, an Allogeneic BMT may be the only chance for a cure. Roughly 30 to 40 percent of such patients can be cured with BMT.

Chronic Lymphoid Leukemia (CLL)

There is limited experience with CLL and BMT. Selected patients, especially those who are younger, could participate in a clinical trial.